Facebook Twitter: @NeosKosmos Instagram What would you guess is the cause of more deaths in women – cancer or heart disease? Most would vote cancer, namely that of the breast; however according to statistics provided by the Heart Foundation, women are three times more likely to die of a heart attack than breast cancer. Adding to that scary statistic is that the primary symptom we have been told to look out for – chest pain – is unlikely to be felt by upwards of 40 per cent of women being affected. Greek Australian Penelope Theodorelos is an example of this, when at 35 she misdiagnosed the pain in her left hand for a tennis injury. “I didn’t think much of it. The pain was there for a few days when I realised it was not going away – it was actually getting worse. I went to my physio who suggested that I had a pinched nerve,” Ms Theodorelos told Fairfax Media.It took weeks of pain, a second trip to the physio and hours in emergency before the pain was finally diagnosed as the sign of an impending heart attack. Despite the lengthy time it took to correctly diagnose the pain, Ms Theodorelos was one of the lucky ones who received medical attention in time before things became fatal. However, it’s not just women who are at risk of ignoring the signs says Dr John Voukelatos, a cardiologist at the Royal Melbourne Hospital. “If we’re looking at chest pain, people may be missed because that may not be the initial presenting symptom. Women, elderly people and diabetic people tend to have fewer symptoms of chest pain and more shortness of breath,” he tells Neos Kosmos. The most likely symptoms women may experience prior to a heart attack are nausea, shortness of breath, dizziness, fatigue and back pain – all fairly generic experiences, which could easily be passed off as something less serious. Combine the varied spectrum of symptoms with the fact that each individual has a different pain threshold and you can understand why it is often hard for people to differentiate between something that is serious to just a one off. “Some people will call any sort of pain a severe pain, the same pain another person might grade as a niggle or maybe interpret it as indigestion. So the interpretation of any sort of bodily pain, in particular chest pain, is always problematic, and certainly women can have a different threshold compared to men and their symptoms may be misinterpreted,” says Dr Voukelatos. Although the Heart Foundation reports that twice as many men experience heart attacks than women, the fatality rate is almost equal, which the cardiologist partially attributes to biology. “Women don’t seem to do as well with procedures as they often tend to have smaller arteries compared to men. So we certainly know that their response to any form of intervention in terms of surgery or angioplasty tends to be not as good, and that may partly reflect the calibre of their blood vessels,” he explains.Blood vessels aside, lack of awareness regarding what symptoms to look out for is one of the most significant factors.And according to Kelie-Ann Jolly, director of cardiovascular health at the Heart Foundation, the lack of awareness also extends to medical staff, who she claims are less likely to consider that a female patient is presenting symptoms of heart disease.“There is also some evidence that medical staff may be more likely to classify women at lower risk of cardiovascular diseases than men despite similar calculated risk, may not recognise [the disease] in women at its initial manifestation, and may have difficulty recognising presenting symptoms in the emergency department, possibly causing delays in access to diagnostic tests and treatment,” she told Fairfax Media. For this reason, the Heart Foundation will be devoting the month of June to raising awareness of women and heart disease, with all Australians asked to do their bit in wearing something red on 11 June 2015.With regards to primary prevention however, Dr Voukelatos recommends men and women endeavour to see their general practitioner on a regular basis, particularly if there is a family history of premature coronary artery disease or if someone is at a higher risk due to smoking, weight, diabetes or hypercholesterolemia.“If any patient has any discomfort from the navel to the jaw, and if it has any relationship to exhaustion or physical activity, or if that patient does have relatives who have had premature coronary disease, they certainly need to see their GP.”For more information regarding heart disease, call the Heart Foundation on 1300 36 27 87 or visit www.heartfoundation.org.au/ for information in English and Greek. In the case of an emergency, dial 000.