Women are treated less aggressively in their initial encounters at the hospital until they 'prove that they're as sick as male patients.'
Mauro Grigollo / Stocksy
No less than five minutes after returning home from a trip to the emergency room—I needed hydration after a bout of what I assumed was food poisoning—I felt the crushing in my chest. My heart felt swollen like a balloon right before it pops.
I’ve had anxiety for much of my life, but I’d never had a panic attack. I sat in bed, paralyzed, for a few hours before I tried to face it. Consumed by terror, I hadn’t considered any options. I would just sit there and wait it out. I punched in the numbers for the hospital I’d just returned from seven times before I actually called. I didn’t wake my partner. I sat in silence for a long time.
When I did get through to the nurse that had seen me earlier in the night, she quelled my fears. “A panic attack will pass,” she said. “You’ve been sick and your body is stressed. Get some sleep.” When I hung up, I cried, but I still didn’t wake my partner.
A day later, I asked my partner to drive me to the hospital. It surprised me when the intake folks rushed me to the back after hearing about my infliction. I zoned out when the doctor starting talking about my damaged heart. I repeated the nurse’s earlier words in my head. A panic attack will pass. A panic attack will pass. I’m sick and my body stressed. I just need to get some sleep.
It had been more than 24 hours since my symptoms arose that I processed the doctor’s words: The panic attack was a symptom of a larger problem with my heart. My blood pressure had dropped dangerously low, and my heart was beating too fast to try and compensate, he told me. My troponin levels—these are the proteins released into the bloodstream when the heart gets damaged—suggested an acute heart problem.
I was a healthy 29-year-old woman with no real health problems other than a bum shoulder. I’ve never stayed a night in the hospital, I’ve never given a second thought to my heart health. I don’t know how the doctor got my phone, but I remember hearing him tell my mom she should probably drive up to be there. The panic attack I was having was actually a symptom of—and subsequently, a misdiagnosis of—the acute heart damage caused by Salmonella-inflicted myocarditis. Doctors initially saw my panic attack as the cause of my chest pain, but it actually turned out to be a symptom of the myocarditis.
The food poisoning I initially suffered from before my chest pains began turned out to be Salmonella. Myocarditis is the inflammation of the heart muscle caused by a viral infection, but it can also be brought on by bacteria—which is what Salmonella is, a bacteria that infects through contaminated food and water.
“It is extremely common that heart symptoms in women, particularly young women, are diagnosed as anxiety,” Sue Varma, a psychiatrist and clinical assistant professor of psychiatry at New York University Langone Health tells me. “Doctors typically categorize patients who are older males as having risk factors.”
Women are “more likely to be treated less aggressively in their initial encounters with the healthcare system until they ‘prove that they are as sick as male patients,’” researchers found in a 2003 study titled “The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain.”Indeed, my initial chest pain was written off as less serious than it actually was—with no consideration of how serious anxiety can be, either.
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Researchers have found a connection between anxiety and the heart, but it’s less understood than the link between depression and heart disease. Stress and anxiety have been associated with an increased risk of cardiovascular problems, though an instance of a heart problem can also cause anxiety, Varma says. The cyclical pattern makes it hard to place where each sits in the process. Anxiety can be a symptom of a heart issue, but it can be a cause, too.
“Anxiety is higher in folks with heart disease,” Varma says. “About five percent of adults in the general population meet the criteria for generalized anxiety disorder.” She adds that the incidence is higher among people diagnosed with coronary artery disease (11 percent) or with heart failure (13 percent). This connection could be due to a variety of factors, like increased heart rate, irregular blood pressure, or abnormalities in heart rate variability.
Anxiety puts stress on the body and the heart. Physical symptoms of anxiety and of cardiac problems mimic each other, Varma says—rapid heart rate, increased or decreased blood pressure, and feelings of terror. Chest pain, of course, is a big factor. Often, patients find themselves in the hospital thinking a panic attack is a heart attack—but a heart problem masquerading as a panic attack is similarly common. A number of tests can discern the difference; for me, it was the results of my blood tests and ultrasounds that showed heart damage. Other issues will present themselves through electrocardiograms or X-rays. “Doctors have to look out for [the symptoms of] both,” Varma adds.
Anxiety finds its way back into life following cardiac problems, too. The fear of it happening again can be debilitating. A tinge in my chest can send me into a spiral. I fear not being able to breathe, the nurses poking when my blood ran dry and looking for a new vein to mine. It’s the tangled wires that I tripped over when I got out of bed, the beeps and boops of monitors tracking my heart.
“I’ve seen folks develop anxiety after heart-related issues due to feelings of vulnerability, uncertainty, feelings of dependence on loved ones, or even the experience of being in the hospital or needing cardiac surgery,” Varma says. “All can cause anxiety.”
She adds that the cyclical nature of anxiety and heart issues could be mediated via cortisol-stress hormones and increased inflammation in blood vessels. Elevated cortisol levels are known to increase blood pressure and the chance of heart disease, as well as raise anxiety levels.
I stayed in the hospital for a week, but my recovery is still ongoing. As my oxygen levels rose, I started to breathe better. The chest pain slowly subsided. The doctors said my heart damage would heal and I likely wouldn’t face the same illness again. But no one warned me about the ongoing fear I’ve felt from it—which is the same fear many others express, too. Page after page of Google results tell a similar story: We’re in recovery from a heart-related illness, we’ve got a great prognosis, but despite that, we’re scared it’s going to happen again. We’re scared of the physical pain, the reliance on others, and the loss of freedom.
It’s hard now to forget what my heart muscle can subject me to—the breathing machines, the fogginess from the drugs, the bright lights that are always on. For the first couple weeks after I left the hospital, I called the doctor every time I felt my heart race or a tinge of pressure in my chest. But instead of a symptom, anxiety is now the root of the problem.
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