Why women should advocate for themselves after delays in heart disease diagnosis

GREENVILLE, S.C. (InvestigateTV) — Heart disease is the biggest threat to women’s health, though studies show many people still believe it is primarily a men’s health issue.

That misconception can be dangerous, as symptoms in women are sometimes mistaken for stress or something else minor, leading to delays in care.

A 2022 study published in the Journal of the American Heart Association found women who went to the emergency room with chest pain waited, on average, 11 minutes longer than men to receive medical attention.

The study also found women were less likely than men to have an echocardiogram, a non-invasive ultrasound test that evaluates heart structure and function.

A runner’s warning signs

Courtney Pace, a South Carolina mother, used to run a few miles a day. In 2024, even walking caused her pain.

“It felt like I was having chest pain, it would go down my arm, like a heart attack,” Pace said.

Pace went to the emergency room, where doctors gave her an EKG, a test that checks the heart’s electrical activity. Her results came back normal. Pace said doctors suggested stress or a hard workout might be the cause and sent her home.

“I left crying,” she said.

Research by the National Institutes of Health shows that during a cardiac event, women are less likely than men to be referred for cardiac diagnostic testing, receive timely treatment or be taken seriously. As a result, heart disease in women is often detected later, when it is more advanced and harder to treat.

UNC Health cardiologist Dr. Essraa Bayoumi said some of the pattern is rooted in historic thinking.

“Cardiovascular disease was seen more as a man’s disease and that women were somehow protected. And so that thought has been ingrained. So it unfortunately is true. We’ve really been behind in understanding and diagnosing and treating cardiovascular disease in women,” Bayoumi said.

Bayoumi said women are also consistently under-represented in landmark clinical trials.

A 2022 study published by the National Library of Medicine found that guideline recommendations for the prevention and management of cardiovascular disease are based on predominantly male participants.

Bayoumi said when tests come back normal, women’s symptoms are sometimes dismissed as something else, like anxiety or “just stress.”

“We use stress as sort of an excuse for their symptoms which is a double-edged sword because truly, stress is actually a risk factor for cardiovascular disease,” Bayoumi said.

Bayoumi said advocating for yourself starts with knowing personal risk factors, including family history, autoimmune disease, pregnancy-related complications like preeclampsia or gestational diabetes, and menopause-related changes.

“And that’s because they’ve lost that estrogen, which we believe is protective,” Bayoumi said. “And that’s why women who have menopause much earlier are at a much higher risk of having cardiovascular disease.”

Cardiologists and experts say women don’t always show “classic” chest pain, which can slow a diagnosis.

In addition to chest pain or discomfort, women may experience nausea and vomiting, unexplained weakness or tiredness, upset stomach, or pain in the shoulder, back or arm.

Experts say because some of these symptoms do not fit the standard heart attack narrative, they are frequently mistaken for panic attacks, acid reflux or bone and joint issues.

A Kentucky mother’s experience

In 2025, it took six stairs for Vivian Tandy to realize something was wrong.

She experienced shortness of breath and chest pain, which interfered with her daily routine. Doctors asked her to wear a heart monitor, but after it came back normal, Tandy still did not feel “right” and expressed her concerns to her doctor.

Her doctor listened and eventually found the cause. In October 2025, Tandy underwent open heart surgery to fix a rare genetic heart disorder.

“They essentially did what’s called an unroofing, and they literally shaved a piece of my heart — it’s really cool,” Tandy said.

Tandy said her decision to keep advocating for herself was connected to her mother, who died at age 47 from heart disease.

“I look in the mirror, and I see that scar, and I look at myself, and I’m like if it wasn’t for my mom, I wouldn’t have done the things that I did to fight for the answer, so I am super proud of my scar,” Tandy said.

A specialist finds answers

Back in South Carolina, Pace’s chest pain persisted, and she returned to the emergency room. This time, she asked to see a specialist. Interventional cardiologist Dr. Vincent Gacad had a hunch of what was going on.

Gacad performed a specialized type of catheterization, which detected coronary microvascular disease, or CMD, a condition that affects tiny vessels that deliver blood to heart tissue that a resting EKG often cannot detect.

“Traditionally, when we see chest pain we think about coronary artery disease or large vessel blockage,” Gacad said.

CMD causes prolonged chest pain, called angina, and increases the risk for heart attack, according to the Cleveland Clinic. It is more common in women, especially those with lower estrogen levels.

Thanks to medication and her treatment plan, Pace said she is feeling much better and has returned to exercising.

“I just got into more of a walk run, this weekend I did two miles, so I am starting to pick up the pace and get back into it,” Pace said.

What experts recommend

Experts suggest that if you suspect something is wrong with your heart, be persistent. Ask your doctor for further heart testing, such as an EKG, a stress test, a blood test for heart markers like troponin levels, or an echocardiogram.

Experts also recommend bringing an advocate, such as a trusted friend or family member, who can help reinforce your concerns.

If symptoms are dismissed, experts say do not hesitate to see another doctor.

Women who feel unheard can also request a female doctor or seek out a specialist, such as a cardiologist with expertise in women’s heart health.