Maria Arzoumanian

English 101
Professor Petrides
11/30/2015
Women and Heart Attacks
Chest pain, sweating, and shortness of breath to most these symptoms
automatically sound like a heart attack. However, through extensive research and studies,
especially through the NIH programs for the last nineteen years, researchers have
discovered that heart attack patterns and symptoms vary between people, in particularly
in gender. Cardiovascular disease, mainly heart attacks have become the leading cause of
death in women. Unlike common beliefs women are as likely to be prone to having a
heart attack as men. Although both genders can experience heart attacks, they are
dissimilar in women and men.
What is heart attack? Heart attack, also known for its medical term acute
myocardial infarction is the death of heart tissue following the rupture of atherosclerotic
plaque in the wall of a coronary artery that causes a blood clot to block the flow of blood
and supply of oxygen through the artery downstream to that area (Kim). Heart attacks
are dangerous and also a life-threatening situation in both men and women. Common
symptoms of heart attacks are chest pain, swearing, and shortness of breath. Although
heart attacks can also occur without any symptoms (Kim), this case is known as silent
heart attacks, which makes it hard for a victim to get the treatment needed. Once a person
has experienced the symptoms, a diagnosis of heart attack is made according to criteria
of a positive history, electrocardiogram, and heart enzymes measured in the blood, as set

out by the World Health Organization. (Kim) At least two out of three criteria are needed
to meet, in order for a person to be diagnosed with heart attack. After the diagnosis of a
heart attack is determined, physicians will proceed by providing the patient with the right
medical treatments. Heart Attack treatments include clot-dissolving medications
(thrombolysis), angioplasty, and coronary bypass surgery (Kim).
Although heart attacks cannot be controlled or prevented, there are few risk
factors that will increase ones risks of getting impacted with a heart attack. Established
risk factors of heart attacks that one needs to be aware of are cigarette smoking, elevated
low-density lipoprotein (LDL) cholesterol, low high-density lipoprotein (HDL)
cholesterol, hypertension, diabetes, physical inactivity, obesity, and low socioeconomic
status (Kim). Age also plays a role in increasing risks of a heart attack. Studies
published in the Encyclopedia of Global Health, average age for first heart attacks to
occur for men is 66 years old and 70 years old in women. Furthermore, researchers have
discovered, the environment one lives in can increase the chances of getting a heart
attack. Research shows, both women and men living in the poorest versus richest
neighborhoods had 1.9 and 1.4 times higher odds of a nonfatal heart attack (Kim).
Lastly, family history of early heart disease can higher the chance of getting a heart
attack, therefore, one should always be aware of their family medical history.
In the 1950s and 1960s people believed a heart disease was a mans problem
primarily. However, researchers discovered heart disease is actually a womans disease. If
people remained sexist, female patterns of heart attack would have never been
discovered. According to Doctor C. Noel Bairey Merz, director of the Womans Heart
Center at the Cedars-Sinai Heart Institute, one out of two women will be impacted with a

cardiovascular problem in their lifetime, especially heart attacks, which is the leading
killer of women. When Dr. Bairey Merz became a cardiologist, she quickly learned that
heart disease studies focused on male patients, while women were widely viewed as
though they were smaller versions of men (Cedars-Sinai). For more than 50 years
physicians had only studied men with heart disease. However, since 1984 more women
have died than men due to heart attacks in the United States, causing a huge wake up call
to everyone. In result of this statistics, researchers started an extensive research on heart
attack patterns involving women only. This female pattern is now known as
Microvascular Coronary Dysfunction. There is now enough research to prove that men
and women are dissimilar.
The dissimilar heart attacks patterns in between men and women has resulted Dr.
Bairey Merz to believe, womens heart disease should be referred to as Ischemia Heart
Disease. Ischemia is a term that indicates a lack of blood flow and oxygen to the heart,
resulting in symptoms such as chest discomfort, shortness of breath and nausea (CedarsSinai). In result, Dr. Bairey Merz and few other cardiologists, created a research study
program called Womens Ischemia Syndrome Evaluation also known as the WISE study,
which got sponsored by National Heart, Lung and Blood Institute.(Gulati) The WISE
Study was designed to optimize symptom evaluation and diagnostic testing for ischemic
heart disease. Explore mechanisms for symptoms and myocardial ischemia in the absence
of epicardial coronary artery stenosis, and evaluate the influence of reproductive
hormones on symptoms and diagnostic test (JACC). The WISE study program has
discovered and concluded that when it comes to heart attacks, women erode but men
explode. According to Dr. Bairey Merz, women experience a heart attack where it erodes,

doesnt completely fill with clots, symptoms are subtle and EKG findings are different.
Due to this misleading symptoms women usually get sent home with diagnosis of vague
chest pain.

Figure 1: TED Talks- Noel Bairey Merz: The single biggest health threat
women face. 2011. Illustrating difference of atherosclerotic plaque due to
heart attacks for each gender.
When it comes to heart disease, women and men are not equal, says Dr. C Noel
Bairey Merz.
Now as research has proven women and men differ in heart disease conditions,
women need to be more aware of the atypical symptoms of heart attack. According to Dr.
Bairey Merz during an interview on the Dr. OZ show, atypical symptoms of heart attack
in women consist of; fullness in the stomach area, shortness of breath, women could also
experience pain only in the jaw area, arm or shoulder, even just a sense of fullness. Also,
some women experience overwhelming fatigue, not similar to daily fatigue. However,
always keep in mind few women do still experience the typical symptoms that men
experience, which are severe chest pain, shortness of breath and sweating. Dr. Bairey
Merz also mentions these atypical symptoms do affect about third of men victims

experiencing heart attacks. Although the atypical symptoms are more common in women
than men, both genders need to be aware of the typical and atypical symptoms.
As previously established, heart attack symptoms in women are harder to
recognize than men, research has shown that women [are not] diagnosed or treated as
aggressively as men (Sutton). Therefore, women in most cases do not receive the same
care as men do, reason being, for the last few decades all physicians were taught in
medical school were about the typical symptoms and not the atypical symptoms. This
medical misunderstanding is now the reason to why more women die due to heart disease
than men. Statistics show each year only in the United States, nearly 250,000 women die
of ischemic heart disease (JACC). Researchers have also discovered the significant
differences between men and women in survival rate after experiencing a heart attack,
42 percent of women who have heart attacks die within 1 year compared with 24 percent
of men (Sutton). This statistic proves that men get the care they need, because the
symptoms are more recognizable while women do not. The lacks of treatments women
receive due to unrecognizable pattern of the heart attack, results in dramatic damage to
the heart and the arteries. The damage caused weakens the heart, which leads up to death.

Figure 2: TED Talks- Noel Bairey Merz: The single biggest health threat
Women face. 2011. Morality rates between heart disease and Breast cancer.

Most people might not agree with the statistics of cardiovascular problems such as
heart attack, is the leading cause of death in women. A lot of people especially women
believe that cancer such as breast cancer is the leading problem in women. However,
experts have estimated that one in two women will die of heart disease or stroke,
compared with one in 25 women who will die from breast cancer (Sutton). Dr. Bairey
Merz stated heart disease kills more women than all cancers combined. To decrease
womens deaths in the United States due to heart disease, cardiologists started working
together to spread the word around through campaigns. It has been established, the breast
cancer campaigns are very good at spreading the knowledge of breast cancer. The breast
cancer campaign also does a great job encouraging women to get a mammogram every
six to nine months. Dr. Bairey Merz believes once people, especially women stand
together to spread the findings about the womens heart attack patters, the same way done
for breast cancer, the deaths in women due to heart attacks will decrease. Dr. Bairey Merz
wants the womens heart attack campaigns to be as good as breast cancer campaigns.
Breast cancer as we said kills women, but heart disease kills a whole bunch more, said
Dr. Bairey Merz.

Figure 3: TED talks- Noel Bairey Merz: The single biggest health threat
Women face. 2011. Graph of mortality in each gender.

Figure number three, represents a graph of deaths among men and women due to
cardiovascular disease (CVD), as of 2011. The left side of the graph demonstrates the
statistics of death within women and men due to heart attacks, before the discovery of
womens heart attack patterns. The right side demonstrates the statistics after the findings
of the dissimilar patterns of heart attack in men and women. As seen in the graph, in
1984, the path crossed causing more deaths in women than men due to heart attack.
Researchers discovered this dramatic change in late 1993. In result of this discovery,
researchers started studying heart attacks involving only women. After the dramatic
findings of women not experiencing heart attack the same way as men, researchers
especially the NIH program, started publishing what they discovered to get an awareness
going. In late 1999 early 2000 the campaigns and studies created by these findings such
as, NHLBI WISE study, NHLBI and AHA Red Dress Awareness and Guidelines
campaign started bending the curve. The bending of the curve was just a start. According
to Dr. Bairey Merz as of 2011, 2 to 3 more women are still dying for every man. Dr.
Bairey Merz mentions, theres still a long way to go, since researches have been working
on women patterns for only 15 years as opposed to 50 years of research focusing only on
men patterns.
The NIH research program, WISE study and also, Dr. Bairey Merz wants for
everyone to learn more about heart attacks involving women. One can get involved by
acknowledging the statistics and keep the word going among friends and family. The
more women are aware of these findings the more women will get the right treatments.
As Dr. Bairey Merz mentions in the TED talk, women are good at going to and joining
awareness campaigns, women advocate, women start fundraisings and they participate to

get the awareness to spread around the world. Once the womens heart disease campaign
becomes as good as breast cancer, a lot of lives will be saved.
As research continues to grow, more discoveries in the medical field will be
made. When heart attack research first began, researchers were only focused on men
heart attacks patterns, assuming women will only experience heart attacks the same way.
However, once researchers examined the statistics of deaths due to cardiovascular
disease, they discovered more women have died as a result of heart attacks than men. In
result of this finding, researches concluded, heart attack patterns are dissimilar in women
and men. Heart Attacks are the leading killer of women. Women need to acknowledge the
new heart attack pattern findings, and be aware of the symptoms. However the first step
for a better future is women need to start creating a better relationship with their heart.

Abstract Paper
Heart attack, also known for its medical term acute myocardial infarction is the
death of the heart tissue, following with the rupture of atherosclerotic plaque in the wall
of the coronary artery that results in a blood clot, which blocks the flow of blood and
oxygen through the artery downstream. When a person hears the following typical
symptoms, severe chest pain, sweating and shortness of breath, automatically one
assumes its a heart attack. However, that is not always the case. Studies have shown,
men and women experience dissimilar symptoms. Men experience the typical symptoms,
however women experience atypical symptoms of heart attacks. The atypical symptoms
are; fullness in the stomach area, shortness of breath, women could also experience pain
only in the jaw area, arm or shoulder, even just a sense of fullness. Also, few women
experience overwhelming fatigue, not similar to daily fatigue. Unlike old beliefs of heart
attacks being a mans problem primarily, studies have proven that theory wrong. Heart
attack is actually a womans disease and has become the leading cause of deaths among
women. Heart attack even kills more women than all cancers combined. Studies done at
the NIH program and WISE study have started to publish the discoveries to inform
people about the dissimilar patterns in men and women. By publishing the discoveries
and informing women about the atypical symptoms of heart attack, it has resulted in a
start of decrease of deaths among women.

Annotated bibliography:

Bairey Merz C, Kelsey S, Pepine C, et al. The Womens Ischemia Syndrome Evaluation
(WISE) Study: protocol design, methodology and feasibility report. J Am Coll
Cardiol. Web.
C. Noel Bairey Merz, MD became a cardiologist, she quickly learned that heart disease
studies focused on male patients, while women were widely viewed as though they were
smaller versions of men. Bairey Merz is also on the chair or WISE study. Her material
was very beneficial to my research because she was very clear about heart attack and how
it affects women.

Bairey Merz Merz. The Single Biggest Health Threat Women Face. TED Talks,
Dec. 2011. Web.
Noel Bairey Merz was asked to be spokesperson on TED talks to publicized issues
women face. In the video she mentions how research has proven heart attacks are the
leading cause of deaths among women. This video was very beneficial, because it was
very clear about the points she was making, also includes subtitles making it easier for
the viewer to follow along. She also mentions few campaigns involving womens heart
disease that she is also a part of.

"Cardiovascular Disorders in Women." Cardiovascular Disorders Sourcebook. Ed. Amy

L. Sutton. 4th ed. Detroit: Omnigraphics, 2011. 303-310. Health Reference Series.
Gale Virtual Reference Library. Web.
Cardiovascular Disorders in Women is a small article, chosen from the Cardiovascular
Disorders Sourcebook by editor Amy L Sutton. This article focuses only on the statistics

of heart attacks involving women. This article was beneficial to me because it provided
me many accurate statistics and surveys, which helped get exact numbers on the
situation. Also the article is very organized and easy to read.

Gulati, Martha, Leslee J. Shaw, and C. Noel Bairey Merz. Myocardial Ischemia in
Women - Lessons from the NHLBI WISE Study. Clinical Cardiology 35.3
(2012): 141148. PMC. Web.
The article Myocardial Ischemia in Women Lessons from the NHLBI WISE Study was
published in the Journal of the American College of Cardiology. The article is a clinical
study done in May 1999 by Martha Gulati, Shaw Leslee and Noel Bairey Merz. The
article is very organized and detailed on the WEB Study. It provided pictures and graphs
to demonstrate each paragraph. This Article was helpful because it explained what the
WISE study was and who are its chair members.

Kim, Daniel. "Heart Attack." Encyclopedia of Global Health. Ed. Yawei Zhang. Vol.
2. Thousand Oaks, CA: SAGE Publications, 2008. 810-811. Gale Virtual
Reference Library. Web.
The article, written by Daniel Kim called Heart Attack was published in the
Encyclopedia of Global Health in 2008. In the article Kim focuses on three main points.
The three main points are, what is heart attack? Risk factors of heart attacks and
treatments of heart attack. This was beneficial because it provided me information to
explain in depth the background and facts of heart attacks before introducing the
dissimilarities of patterns between men and women.