Having a heart attack is scary enough. Patients should not have to worry about getting good care.

A recent study showed that women admitted to the hospital for a heart attack who then developed cardiogenic shock (the heart doesn’t pump enough blood) were 11% more likely to die than men.

Equally alarmingly, Black women were more likely than men or white women to have a heart attack followed by cardiogenic shock.

The research was led by Saraschandra Vallabhajosyula, MD, a fellow studying interventional cardiology at Emory University School of Medicine in Georgia. “It is very concerning that the young, productive women of our society face these healthcare disparities,” he said in a press release.

What is a heart attack?

So, what is a heart attack and who gets them? A heart attack occurs when the body cannot get oxygen-rich blood to the heart, usually caused by a blockage, like a blood clot. As the heart is deprived of oxygen-rich blood, heart tissue dies. Eventually, if enough damage is done, the heart will stop pumping, causing a cardiac arrest. Heart attacks aren’t always fatal, but they can cause subsequent problems, such as cardiogenic or cardiac shock.

But why is this especially deadly in women? This study focused on people aged 18 to 55 who had had a heart attack. Out of a little over 90,000 cases, about a quarter were women.

Once at the hospital, the researchers found that women missed out on care. Women were less likely to get a coronary angiography, a procedure that provides radiology images of the heart in real time to show if there is a blockage. They were less likely to get a stent or balloon, medical tools that open up blocked arteries, allowing for blood flow. And, they were less likely to get a mechanical pump to help their heart do its job.

It was not clear that the reduction in treatments in women caused an increase in death. The authors said they needed to do more research, but both findings are independently not good.

Is there a bigger reason this is happening? One reason is that the stereotypical face of heart attacks is an older man clutching his chest.

The American Heart Association (AHA) explains: “ We’ve all seen the movie scenes where a man gasps, clutches his chest and falls to the ground. In reality, a heart attack victim could easily be a woman, and the scene may not be that dramatic.”

The AHA lists the symptoms of a heart attack as:

  1. Uncomfortable pressure, squeezing, fullness or pain in the center of your chest. It lasts more than a few minutes, or goes away and comes back.
  2. Pain or discomfort in one or both arms, the back, neck, jaw or stomach.
  3. Shortness of breath with or without chest discomfort.
  4. Other signs such as breaking out in a cold sweat, nausea or lightheadedness.
  5. As with men, women’s most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting and back or jaw pain.

Sometimes a woman’s heart attack doesn’t seem the same as a man’s. She might have different symptoms and might not have chest pain at all. A report from 2018 found that women waited longer than men to go to the hospital, and when they got there had a longer wait time before treatment.

There is a strange silver lining here. According to research done on matching doctor-patient gender, when male doctors treated women with heart attacks, more women died. But, when women treated women, they survived at the same rate as male patients. Here’s the good news: when male doctors worked with more women or treated more female patients, they got better at treating heart attacks in women.

Bottom line, this is a problem, and there is more work to be done. “Additional studies are needed to help us more fully understand and make the changes necessary to improve treatment and eliminate disparities in care,” said Dr. Vallabhajosyula in the same press statement. There may be differences in the symptoms of women with heart attacks, and it does seem that race and gender can mean women have worse outcomes, but that can change.

Sabrina Emms is a science journalist. She got her start as an intern at a health and science podcast out of Philadelphia public radio. Before that she worked as a researcher, looking at the way bones are formed. When out of the lab and away from her computer, she's moonlighted as a pig vet's assistant and a bagel baker.