Health: Heart attack? But I'm a woman . . .: Everyone thinks it's a disease that only strikes men; for a woman it's just a pain in the chest. Lee Rodwell explains that the truth is very different (CORRECTED)

CORRECTION (PUBLISHED 20 SEPTEMBER 1994) APPENDED TO THIS ARTICLE

Sally Curtis and her family had spent the day with friends. After a light lunch and a little wine, she drove home to London. She carried her seven-year-old son upstairs and put him to bed. Then she sat down to watch television. As her husband, David, dozed beside her on the settee she began to feel nauseous. At first she thought she had overdone the taramasalata. Then she felt an intense pain in the middle of her left hand.

Her husband suggested she went up to bed. 'I don't think I can,' she replied. Now there was a pain in her chest, accompanied by the sensation of being strangled from the inside. The pain in her hand had moved up her arm and there was also 'the weirdest feeling along her jaw, running from ear to ear'. Sally was having a heart attack. Even her GP, who was called out by David, failed to recognise what was happening. After all, she was only 39. 'Most women have no idea that heart disease affects them as much as it does,' says Dr Graham Jackson, a cardiologist at Guy's Hospital, London. 'They worry that the men in their life could get it, but not them. Everyone knows it's only a man's disease. The trouble is, everyone's wrong.'

New research in the British Medical Journal suggests that women who have heart attacks receive inferior treatment compared with men, and are less likely to survive as a result. Statistics show that up to the age of 65, women have a 10-year advantage over men when it comes to heart disease. After this the rates level up. Pre-menopausal women seem to be partly protected by their natural production of the hormone oestrogen, but one in four of the women who die from a heart attack before their 65th birthday is under the age of 45.

Sally came close to death. She was taken to Queen Mary's Hospital, Roehampton, south-west London, and admitted to the coronary care unit. Even then she found it hard to believe what had happened. 'It was only months later I found out they'd told David they didn't know if I would last the night. They'd given me a clot-

busting drug and a shot of morphine and I felt fine. I wanted to go home.

'David and I were running our own publishing company and it was going through a tough time. I had a son to look after. Nothing was bleeding, nothing was visibly wrong. I couldn't get my head round it.

'There was no family history of heart disease. I was a non-smoker, I drink normally. I'm not a great health freak in terms of exercise so I suppose I could be termed unfit, but not excessively so. I wasn't overweight.

'If a man gets a pain in his chest he is likely to think about a heart attack. If a woman gets a pain in her chest she is likely to think it's just a pain in the chest - and to hope it will go away by itself.'

Constance Walker, 54, is deputy manager in a wine shop. She noticed pain and tightness in her chest after moving some heavy boxes. At first she put it down to indigestion, but by the end of the week she was feeling unwell. When the pain returned, worse than before and more persistent, she went to her GP. He diagnosed angina. 'I was very surprised,' she says. 'I thought angina was a man's disease.'

Constance, from Margate, Kent was prescribed a spray containing nitrates to squirt under her tongue when the pain came on. However, last December, after a particularly demanding time at work, she woke in the night with a chest pain radiating into her shoulder and down her arm. This time the spray did not help and she was admitted to hospital. She, too, was having a heart attack.

In August Constance had a quadruple bypass and is still recuperating. 'It's wonderful to wake up in the morning and get out of bed without puffing. But I do want to warn other women to be aware this could happen to them. I thought this affected men and the elderly. You never imagine a 54-year-old woman is going to be struck down with a heart attack.'

Dr Jackson stresses that all women should be aware of the risks and should take steps to minimise them. 'It is fashionable for young women to smoke, but smoking is the biggest risk factor for heart attack.'

He believes that every woman should know her blood pressure. 'She should have it taken when she is 20, and again every five years. When she reaches 40 she should have it checked every year.

'If there is a strong family history of heart disease she should also have her cholesterol levels checked. And when a woman reaches menopause she should go to her GP and discuss the pros and cons of hormone replacement therapy.'

He urges women to watch out for the symptoms of heart disease. 'If you get chest pains when you do something that requires effort, or if you find yourself lagging behind your husband or children when you are out walking, if you get a feeling of tightness in your chest, then go to your doctor.'

'The good thing is that for a large number of people the heart can be fixed. So if you're young and have angina you need an angiogram. Without an angiogram your doctor is effectively making decisions based on guesswork.'

An angiogram is carried out under local anaesthetic. Dye is passed through the coronary arteries so that X-rays can reveal any narrowings which might be corrected either by angioplasty or a bypass.

Sally had an angiogram. 'It wasn't pleasant - now I know how a microwaved chicken feels. But at least I knew nothing needed to be done surgically.' Even so, getting back to normal was not easy. Sally rejected the hospital's rehabilitation programme - 'the needs of an average 70-year-old and my needs had got to be poles apart'. She found other people's attitudes difficult to deal with.

'At first, everyone around me was very shocked. They wanted to cocoon me. And no one knew what to say. I found myself having to care for others, even in hospital. The staff tell you that you have to think of yourself, not your business, not your husband, not your son. That's all very well, but your responsibilities don't diminish.

'Having a heart attack led me on a rediscovery of self. It made me think about what I wanted to do, where I wanted to go.'

Sally's heart attack was in May 1993. She recently went back to work after almost a year and a half of doing next to nothing. 'I've been told I'm now healthier than most of the nation,' she says.

Before her son went back to school she took him to Paris. 'We climbed 234 steps to the top of the Arc de Triomphe. My heart was beating 19 to the dozen by the time I got there, but I felt a real sense of triumph.'

CORRECTION

Amplification

An article on the Health page on 13 September about women who have had heart attacks referred to the case of Sally Curtis. Her GP has asked us to point out that although he initially doubted Ms Curtis was suffering a heart attack, he arranged for her to be admitted immediately to hospital, where her condition was diagnosed.