C. Maya

Disease under-diagnosed, under-treated among them

Symptoms are often atypical in women

Risk factors growing among them

Thiruvananthapuram: Heart attacks among women continue to be under-investigated, under-diagnosed and under-treated even though the incidence of heart diseases among them has been growing in the past decade.

According to U.S. data, cardiovascular diseases are the leading cause of death among women worldwide, with the number of women dying due to them being twice as many as those dying from cancer.

Unfortunately, very little women-specific data on heart diseases is available in Kerala or in India. But doctors say the number of women reporting to clinics with cardiac attacks has certainly been going up.

From young age

Traditionally, it has been believed that heart diseases among women are uncommon as they are oestrogen-protected. But since the early 90s, doctors have realised that not just menopausal women, even those younger in age are prone to heart attacks. The number of heart attacks might be more in the menopausal group, but the incidence in the pre-menopausal group has been growing.

“Women rarely report any chest pain or other discomforts that they may be feeling. Even when women voice these symptoms, these are often dismissed as anxiety or panic attacks by their spouses as well as doctors,” says Tiny Nair, chief cardiologist, PRS Hospital, here.

According to data from the intensive care unit at PRS Hospital, of all the cases of heart attacks admitted to it in 1996, 22 per cent were women. By 2006, the number had gone up to 41 per cent. “Women are as prone as men to conventional coronary diseases. But may be because the classical symptoms of a heart attack are often absent in women, doctors do tend to disregard their chest pain to a large extent,” says G. Vijayaraghavan, the former Head of Cardiology of Government Medical College Hospital and chief consultant at KIMS hospital.

He says that at least three new cases of women with heart problems come to him every month. Of the total cases in the Cath lab at KIMS, 30 per cent are women.

The classical risk factors for heart diseases – diabetes, hypertension and obesity – have been growing at a phenomenal rate among women in the State. Culturally too, women generally disregard their health problems. They do not find time for regular exercise and seldom report to doctors for regular medical tests.

But these apart, there are specific gender differences in the manner in which heart attacks are reported, diagnosed and treated when it comes to women.

Need for awareness

There are significant differences in the clinical presentation of heart attacks in women. “The symptoms of heart attacks in women are often atypical and hence a lot of cases go missing even when the women come to hospitals. Sudden deaths can happen in women also. More awareness needs to be created among the general physicians about this,” Dr. Vijayaraghavan says.

Dr. Nair says that rather than just chest pain, women may experience abdominal pain, pain in the neck and shoulders, nausea and vomiting and just plain fatigue, which is not recognised by the patient as a heart attack. This is one of the reasons why women with heart attacks report to the hospital much later than men with the same condition.

Even after women arrive at an emergency unit, there is delay in their diagnosis and treatment. They are likely to be sent back with some medication rather than be admitted to a coronary unit. Dr. Nair says that even though procedures such as angioplasty and bypass are now commonly done for women, these procedures are technically more difficult to perform in them as their coronary arteries are very small. And women actually do worse than men after a bypass surgery in terms of post-surgical complications or the rate of recovery.


Another risk factor for women is Syndrome X or angina, which is the classical chest pain owing to insufficient blood flow to the heart. The treadmill test will show positive, while the angiogram might be normal. This condition is very common in women but often goes undiagnosed. It is important that this problem is recognised and treated because it increases the risk of heart attacks. Passive smoking, long-term use of oral contraceptive pills and early hysterectomies are specific risk factors for women in the Indian context and need more attention, Dr. Nair says.