Two-thirds of primary care doctors in the Baltimore area don't know the sometimes subtle symptoms of heart disease in women, according to a new Gallup survey to be released today. .
Only a third of the physicians correctly identified some of the most significant signs of heart disease in women, such as chronic fatigue, dizziness and nausea.
The survey, commissioned by Union Memorial Hospital, found that about 80 percent of doctors cited crushing chest pain as a major warning sign, for example, when this symptom is more common in men.
Across the country, the lack of awareness among physicians of the gender differences in heart disease has devastating consequences. Experts say the disease in many women isn't diagnosed until they are very ill; others are wrongly sent home from emergency rooms, only to have heart attacks later and die.
"It really is a huge public health issue, and I think that it's not only the physicians that may not understand the importance of this, but the women themselves and their families," said Dr. Michael Rubinstein, director of the Women's Heart Disease Initiative at Union Memorial.
As a response to the survey findings, Union Memorial and other hospitals in the MedStar Health network are launching an education campaign. The American Heart Association and other organizations have conducted similar efforts to alert patients and physicians to signs of the disease.
Heart disease is the leading killer of men and women. One in three women dies from heart disease and stroke, more than twice as many as die from all cancers combined.
But women have different symptoms than men -- symptoms that can seem vague and innocuous -- so many physicians don't think of heart disease when a female patient complains of lightheadedness or nausea. To make matters worse, some of the standard diagnostic tests for identifying heart disease are not as accurate in women as they are in men, doctors say.
Rubinstein noted that about 70 percent of primary care doctors didn't know that some diagnostic tests, such as a stress echocardiogram, are more sensitive and specific to women. Also, about 45 percent of the physicians interviewed said the greatest health risk for women over 50 wasn't heart disease. Instead, they named conditions such as breast cancer, osteoporosis and AIDS.
"That was pretty shocking," said Dr. Jeffrey Gaber, an internist at Mercy Medical Center who is board certified in geriatrics and also teaches at the University of Maryland School of Medicine. He said that his index of suspicion for heart disease in women is high and that he often orders stress tests for female patients. "But I think the older school doctors aren't as aware of this issue," he said.
Dr. Edward Miller, medical director of MedStar Physician Partners in Baltimore, which has more than 1,000 primary care doctors and specialists in Maryland, said he thinks many doctors got the training but need to be "re-oriented."
"It's not something they don't know," Miller said. "A lot of people have fallen into the trap of looking for the classic chest pain."
Doctors advise that women not interpret all of their vague symptoms as heart disease. Fatigue is one thing, but overwhelming fatigue, the kind that makes it impossible for a woman to finish routine tasks, is more of a heart disease warning sign. Also, nausea after a meal might simply mean a woman needs an over-the-counter stomach medicine; nausea after she walks up a flight of stairs could mean a heart attack. Waking up short of breath at night is a flag for anyone.
`Never crossed my mind'
Nancy Loving didn't know any of this when she woke up four years ago at 4: 30 a.m., with pressure in her upper back, nausea and clamminess. She tried walking around and drinking a glass of milk, but the Bethesda woman only grew more nauseated and lightheaded. Finally, her daughter drove her to Suburban Hospital. Within 10 minutes, doctors discovered that Loving was having a heart attack. She was 48.
"It never crossed my mind in a million years that I would ever have heart disease," Loving said. She was an occasional smoker, and her father and three uncles all died young from heart disease. But she -- and her physicians -- instead were worried about the possibility of Loving's inheriting breast cancer from her mother. When her cholesterol was finally measured, it was off the charts.
"I was a walking heart attack waiting to happen," said Loving, who owns a public relations agency. She and other patients have formed a support and advocacy group, the National Coalition for Women with Heart Disease (womenheart.org).