A woman in her mid-40s arrives at the emergency department complaining of chest pain. She may be told by a well-meaning physician that what she’s experiencing is anxiety or possibly a panic attack. Maybe it’s indigestion, acid reflux, or musculoskeletal pain. But it’s less likely that she’d be diagnosed with a myocardial infarction, or heart attack. Too often, she’ll be sent home only to return the next day. They’ll test her troponin levels, which will be high enough to signal a cardiac event requiring immediate medical attention. [JAMA]

This is an all-too-common encounter that patients through the years have described to cardiologists Jason Kovacic, MBBS, PhD, and Harmony Reynolds, MD.

However, it may serve as the best-case scenario for premenopausal women experiencing acute coronary syndrome (ACS). “There are many patients making their way to specialists in heart disease for a second or third opinion because they aren’t getting a diagnosis,” said Reynolds, a cardiology professor at the New York University (NYU) Grossman School of Medicine. “They end up going to multiple cardiologists to feel like they’ve got somebody who is treating them with confidence.”

Kovacic, director of the Victor Chang Cardiac Research Institute and a professor of medicine at University of New South Wales in Sydney, Australia, called this a clinical “blind spot.” Younger women are considered at lower cardiovascular risk than other groups, but, he explained, the long-standing misconception that heart attacks only happen in older individuals or younger men is harming this particular patient population.

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