Virtually all of the information about symptoms and treatment of coronary heart disease in women has been based on information from studies on men, according to information provided by American Medical Women's Association Inc. in Alexandria, Va.
Studies have shown that women's symptoms, diagnosis and treatment are different from men's, says Dr. Patricia Davidson, a Washington, D.C., cardiologist.
"Heart pain is not painful," she says. Those who have chest-grabbing pain, "the elephant sitting on your chest" kind of pain are lucky, she adds.
Women are stoic, Davidson believes. "Anything under labor is no big deal."
Many women who have heart disease experience fatigue, shortness of breath and weakness. The fatigue is different from the daily tiredness you feel when you have 5,000 things to do, Davidson says.
Often family members notice a loved one's fatigue. A concerned daughter called Davidson because her mother couldn't complete her regular shopping at Bloomingdale's.
Davidson says women are at a disadvantage because the cheapest testing - the simple treadmill stress test done in a doctor's office - does not always detect heart disease in women.
Nonspecific symptoms such as fatigue and shortness of breath are not accepted by many health maintenance organizations as reasons for doing more expensive cardiac testing with radio isotopes or sonograms, Davidson says.
Also, despite the fact that women respond well to treatment for high cholesterol, it often goes untreated, Davidson says studies show.
"It (heart disease) is not a disease to fear. It is a disease to prevent," Davidson says.
Pam Cole agrees. She had a heart attack nearly two years ago. She was 42 years old. She calls her heart attack a wake-up call, and has made major changes in her lifestyle. "There's nobody telling me to do it," she says. But she wants to be here for her children, Kellyn, 10, and Hannah, 7.
Although her blood pressure had been high for a couple of weeks, Cole didn't have symptoms that made her think she was having a heart attack on July 19, 1996, as she was packing for a family vacation to Orlando, Fla. She felt achy - like she had the flu - but worse. Her jaws ached and the discomfort spread to her neck and chest. She said she didn't feel well and her husband, David, drove her to her doctor's office.
The doctor sent her immediately to the emergency room, a cardiologist ran tests, and the heart attack was confirmed that night.
Cole was taken to University of Maryland Hospital in Baltimore and had angioplasty - a process in which a balloon attached to a heart catheter is inflated over narrowed areas in the heart - in two arteries. One was 50 percent, the other 90 percent, blocked.
Cole was at risk for cardiovascular disease. Her father had an incapacitating stroke at the age of 64. Her mother has hardening of the arteries. A teacher of special needs children at Marshall Street School in Hagerstown, Cole has the typically busy life of a wife and mother with a demanding full-time job outside her home. She says she always intended to exercise, but put it aside.
"We have to take responsibility and do preventative things," she says. Cole reads everything she can about heart disease and nutrition. She's changed the way she and her family eat, and she makes time for regular exercise at The Wellness Center at Hagerstown Junior College. She tries to keep stress to a minimum.
She says she always has questions for her doctors and believes she's entitled to answers. "I'm paying for it," she says.
Cole's daughters are well-versed in how to prevent a heart attack. They are active in sports, try to eat right and take walks with their mom.