cardiologist: 'we’re not just small men'

disparities in medical treatment between men and women take place across a range of diseases and functions, but particularly egregious inequities are found in heart and stroke disease research and treatment.today, the heart and stroke foundation released its 2020 spotlight on women report, two years after launching its women’s campaign to provide more equitable research.heart disease is the leading cause of premature death among women, but two-thirds of the research is focused on men. women are 25 per cent more likely to die after aortic valve surgery. as well, spontaneous coronary artery dissection (scad) is an under-diagnosed form of heart disease that disproportionately affects young pregnant women. eighty-eight per cent of scad patients are women and it can be hard to detect on a traditional angiogram.“we’re not just small men, we’re actually different,” said dr. paula harvey, the director of the cardiovascular resaerch program at women’s college hospital and a heart and stroke spokesperson.”we need to be making sure that they’re using both female and male animals. then when research is being done in humans, that women are being recruited into clinical trials so we can make sure we’re getting the information we need on risk factors, how we should be diagnosing and treating it.”also making early diagnosis difficult is that fact that there are some risk factors for heart disease that aren’t generally considered as such.“[depression] is not commonly recognized as a risk factor, yet we’re finding that if you have depression you’re more likely to have a severe heart attack, have worse outcomes during the recovery, and even die from it,” said harvey.organizations like heart and stroke and the canadian institutes of health research (cihr) have now made it compulsory for researchers to consider sex and gender in their writing and to include these differences in their proposals in order to get funding.these disparities however, exist not only in sex but in the gendered expectations of women. post-heart attack, it is common to attend a cardiovascular rehabilitative program, but women are 50 per cent less likely to be referred. even if they are, they’re more likely to be caregivers who can’t take the time off or have transportation issues, “like not driving or not feeling safe taking the ttc,” says harvey.karen narraway first experienced a high pulse and chest pains in 2015, upon which her family doctor started her on beta blockers and recommended her to a cardiologist for an echocardiogram. they said it was probably related to anxiety. by march 2016, her chest pains were so severe, prompting bloodwork and an ekg. the diagnosis was the same: she was just stressed.“i had a fairly stressful job [as a nurse], my mom had passed away early that year and i was in menopause so that’s what it was put down to at that point,” says narraway. “part of me was confused as well because i wasn’t feeling anxious or stressed. i felt like i was just being brushed off because i was a woman in menopause and these are the kind of symptoms that you have.”when she developed abdominal pain around october of that year, her family doctor arranged an ultrasound of her gallbladder, a colonoscopy and an endoscopy, the results of which all came back fine. with no resolution to the pain, narraway’s doctor again referred her to a cardiologist, who found a lack of oxygen going to the left ventricle in her heart. after an angiogram, they found six arteries that were between 80 to 95 per cent blocked. on july 12th, 2017, she had quadruple bypass surgery.she dealt with ptsd afterwards from the ordeal.“i was exhausted all day and also hypervigilant, doing everything i was advised to, walking the exact amount of times they told me to walk each day,” said narraway. “when i did sleep, i would have horrific nightmares.”harvey and narraway both have similar messages for women who feel they may have a heart condition.“it’s one thing for women to be aware, but it’s another for them to learn about their risk factors,” said harvey. “[it’s important to ask] their primary care provider [about potential risks] and make sure they’re aware of them at different times in their life.”“i would tell other women to listen to their own bodies and not doubt the symptoms they’re having,” said narraway. “really advocate for themselves with their healthcare workers, and understand that women are experts of their own bodies and they know when something is wrong.”the heart and stroke foundation has given $4.3 million to 27 research teams across canada focused on women’s heart and brain health.