April 16, 2024 – Toniya Farmer was driving on a highway in Atlanta when she experienced severe chest pain. She called 911, experiencing pain and difficulty respiration and believing she was in imminent danger.
When she got to the local emergency room, she said she was having a heart attack. But nobody from the hospital staff responded until a person within the waiting room asked loudly if anyone had heard her.
“I guess I looked too young to be having a heart attack,” Farmer said.
Her story illuminates the larger issue of gender disparities within the diagnosis and treatment of heart disease. Results from the 2014-2020 National Hospital Ambulatory Medical Care Survey showed that U.S. women who visit emergency rooms wait a median of 29% longer to be seen and evaluated for a heart attack than men.
These delays could be life-threatening, especially for young women who’re susceptible to spontaneous coronary artery dissection (SCAD), a style of heart attack that accounts for up to at least one in three acute cardiac events in women under 50.
“There is still a stereotype that heart attack patients just look like older, white men,” said Erin Michos, MD, director of ladies's cardiovascular health and associate director of preventive cardiology on the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease in Baltimore. “SCAD patients don’t have the risk factors we think of for a heart attack; They have normal cholesterol and blood pressure, tend to look healthy, exercise regularly and eat a healthy diet.”
Getting to the guts of SCAD
Unlike most heart attacks (which result from the formation of plaque or blood clots within the arteries), SCAD results from a tear in the center layer of the artery partitions, where blood begins to pool, resulting in the separation of the wall layers. This eventually restricts blood flow. The average patient is premenopausal and between 44 and 53 years old, but SCAD can also be chargeable for 15 to 43% of heart attacks in women who’ve recently given birth.
Researchers imagine that SCAD could also be related to hormones and their influence on connective tissue, in addition to pre-existing connective tissue diseases Ehlers-Danlos syndromeor abnormal cell growth within the artery partitions (fibromuscular dysplasia), which causes the arteries to bulge.
Another theory assumes immense emotional or physical stress.
“In about 50% of cases we see extreme emotional stress and in about 20 to 30% we see very intense exercise,” Michos said. “We hypothesized that these stressors boost the sympathetic nervous system, blood pressure and heart rate go up, and that adrenaline rush occurs; This could be the trigger for the event if the artery is already fragile or prone to rupture,” she said.
Faces from SCAD
The lack of answers and knowledge about SCAD has a big impact on women affected by it.
“The frustration of these patients is real,” said Dr. Sharonne Hayes, founding father of the Women's Heart Clinic at Mayo Clinic in Rochester, MN. “You’re not getting any answers. They’re afraid they’ll die because they’ll get another SCAD,” she said.
Nakeia Jackson is a traveling nurse living in Alton, IL. At the age of 28 she had her first heart problems. Jackson, 34, said she doesn't trust small community hospitals to do the precise thing. “They don’t know how to deal with them,” she said.
After 24 hours of stabbing chest pains and no response, she went straight to Barnes Hospital in St. Louis and the doctors who would save her life.
“I was taken aback,” said Jennifer Maxwell of Cedar Rapids, IA. She had her first of three SCADs at age 40. Maxwell, now 55, said she was training for a marathon outdoors in the course of the cold Iowa winter when she woke up in the future with tightness and pressure in her chest and shortness of breath. She went to an area hospital.
“The hospital didn’t take it seriously,” she said. “They didn’t put any monitors on me, didn’t call a cardiologist, didn’t do an EKG,” she said. “I felt unheard,” she said. “The doctor who treated me told me that I was 40 years old and healthy and that it was just fear.”
SCAD Sisterhood
SCAD leaves an indelible mark. Initial treatments range from watchful waiting to medication management and advice on avoiding highly strenuous activity and heavy lifting, all aimed toward circumventing potential triggers. However, the evidence for these treatments is patchy and slightly weak. “We are guided by incremental evidence. We’ve made some big breakthroughs, but we’re not there yet,” Hayes said.
Doctors also cannot predict which women will experience a reoccurrence of the condition, a dilemma that leaves many ladies with psychological problems as they address the results. “It's understandable; they were young and doing everything right, and then something bad happened to them,” Michos said. “They live with anxiety, but too much anxiety can make the situation worse. That's why part of my counseling is to help patients to encourage people to get help for stress and anxiety.”
The lack of evidence and sound medical treatment has kept many of these women together far beyond the confines of clinics and emergency rooms. Connecting with others with similar experiences has made a significant difference in her life.
“I feel empowered,” said JoAnn Girardo, a 61-year-old SCAD survivor. She attributed much of her success to a corporation called “ women's heart, There she found invaluable resources that eventually led her to volunteer as a Champion, a group of advocates and educators.
“Seeing other women doing well, not just surviving, is very encouraging,” she said. “Others have found comfort in this SCAD researcha nonprofit organization that raises funds to support scientific research, provides education, and runs several groups on Facebook for survivors and their families.
When you ask these women what they wish they had known before their SCAD, the advice they quickly come up with is:
- Girardo: “Learn to use your words correctly and don’t downplay your situation; The doctor only knows what you tell her.”
- Farmer: “Find a doctor who agrees with you. If you see a doctor who doesn’t give you an answer or doesn’t answer the questions you ask, go to another one and don’t stop until you get the answer you need.”
- Jackson: “If you have symptoms that you think might be a heart attack, get checked out immediately. A lot of doctors aren’t familiar with SCAD, so you really have to advocate for yourself.”
- Maxwell: “If you talk to the emergency room and say you have chest discomfort, you can't assume that anyone knows it's your heart. Women show heart symptoms differently than men. So you have to make sure you fight for yourself.”