When he clutches his chest, gasping, everyone knows it's a heart attack. When she mentions fatigue, nausea, and an odd pain radiating into her jaw, the emergency physician considers anxiety, acid reflux, maybe a virus. He orders Pepcid and Ativan. She goes home with reassurance. Eight hours later she's coding in her kitchen, and the paramedics can't bring her back.
Heart disease kills more women than all cancers combined, but it's still diagnosed and treated as if it were primarily a male disease. That diagnostic bias costs lives every day.
Time Is Muscle
During a heart attack, blocked coronary arteries starve heart muscle of oxygen. Every minute the blockage continues, more muscle tissue dies. The damage is cumulative and permanent—dead heart muscle doesn't regenerate. Cardiologists call it "time is muscle" because that phrase captures the urgency perfectly: delay measured in minutes translates directly to heart function lost forever.
The treatment window is unforgiving. Ideally, blocked arteries get opened within 90 minutes of hospital arrival. At three hours, significant damage has occurred. Beyond four or five hours, the opportunity to salvage meaningful amounts of heart muscle has largely passed. What could have been a minor heart attack with full recovery becomes major cardiac damage with a lifetime of consequences.
When emergency departments send patients home with undiagnosed heart attacks, they send them home to die or to suffer damage that didn't have to happen.
The Symptom Problem
The Hollywood heart attack—clutching the chest, left arm going numb, dramatic collapse—is real, but it's not the only presentation. It's not even the most common presentation in women. Female heart attack patients often experience shortness of breath without chest pain, profound fatigue, nausea and vomiting, pain in the jaw or neck or back, dizziness, and what they describe as indigestion.
These symptoms don't scream "heart attack" to doctors trained on textbooks written about male patients. They sound like anxiety, like GI distress, like vague complaints that busy emergency departments see dozens of times daily. The woman who presents this way waits longer for evaluation, receives fewer cardiac tests, and is more likely to be sent home with an undiagnosed cardiac event than a man with classic symptoms.
The research on this disparity is extensive and damning. Women having heart attacks wait longer in emergency department waiting rooms. They receive fewer EKGs and cardiac enzyme tests. They're more likely to be diagnosed with non-cardiac conditions and discharged. They die of heart disease at higher rates partly because the medical system doesn't recognize their heart disease when they present with it.
The Single Troponin Problem
Troponin is a protein released when heart muscle is damaged. Elevated troponin levels in the blood indicate that a heart attack has occurred or is occurring. But troponin takes time to rise—a patient in the early stages of a heart attack may have normal troponin levels that won't elevate for another few hours.
This is why serial troponin testing—multiple measurements over several hours—is standard protocol for patients with possible cardiac symptoms. A single negative troponin doesn't rule out heart attack. It means the test was negative at that moment. Discharging a patient with ongoing symptoms based on one normal troponin is negligent, yet it happens repeatedly in emergency departments under pressure to move patients through.
Who Gets Missed
Beyond gender, certain patients face elevated risk of cardiac misdiagnosis. Younger patients don't fit the stereotype, so their symptoms get attributed to other causes. Diabetics may have nerve damage that mutes chest pain, presenting with silent heart attacks that only show up on testing that never gets ordered. Patients with documented anxiety face the particular danger of having every subsequent symptom filtered through that label—she's anxious, this is probably panic, never mind that panic symptoms overlap substantially with cardiac symptoms.
The Standard of Care
Any patient presenting with symptoms that could possibly be cardiac in origin should receive an EKG within minutes of arrival. Initial troponin should be drawn promptly, with serial measurements at appropriate intervals. Patients shouldn't be discharged with ongoing symptoms and a single negative troponin. Cardiac risk factors—family history, smoking, diabetes, hypertension—should lower the threshold for cardiac workup, not provide false reassurance. When initial tests are inconclusive but clinical suspicion remains, further workup is required.
Sending a patient home with chest pain and a single negative troponin doesn't meet the standard of care. Telling a woman her jaw pain is probably anxiety without any cardiac evaluation doesn't meet the standard of care. These shortcuts save emergency department time at the cost of patient lives.
What's Lost
When heart attacks go undiagnosed until it's too late for effective intervention, patients lose heart muscle that could have been saved, heart function that won't return, years of life expectancy, and sometimes their lives entirely. Survivors face heart failure requiring lifelong medication, exercise intolerance that ends careers and hobbies, the constant awareness that their hearts are damaged and vulnerable, and the particular anguish of knowing it didn't have to be this way.
These aren't minor consequences. When hospitals and doctors fail to diagnose heart attacks in time, the resulting damages are substantial—and the law provides a mechanism to hold them accountable.