Surviving a ‘widowmaker’ heart attack, with Carolyn Thomas

[00:00:02] Hi, if you're new to Overlooked, welcome. Overlooked was created to fill a gap in storytelling around women's health and give voice to stories that often go unheard. We've done episodes about ovarian cancer, ADHD, cervical screening, and endometriosis. So check out our back catalogue. And if you'd like to suggest stories or topics that we can do, get on our mailing list by signing up at overlookedpod.com.

[00:00:34] Carolyn Thomas, I'd like to start this story by saying that you would not even be talking to me today had I not been misdiagnosed in mid heart attack. Carolyn Thomas lives in British Columbia on the west coast of Canada. Carolyn Thomas, I'm a heart attack survivor and heart patient activist. Carolyn has a deeply unsettling story about surviving a heart attack. Carolyn Thomas, I was at the end of the week's wake.

[00:01:02] Carolyn Thomas, my story starts two weeks before I was hospitalized. Carolyn Thomas, I was out for an early morning walk and suddenly out of the blue, I felt this sudden central chest pain, nausea, sweating, and pain down my left arm. And it was so overwhelming I had to lean against a tree just because I couldn't walk. Carolyn Thomas, I was in the middle of the week's wake.

[00:01:27] And I remember thinking, this better not be a heart attack because I do not have time for this today. So on one level, I knew something was terribly, terribly wrong. And it was my left arm pain. You'd think it would be the chest pain that would have frightened me and convinced me that this is a heart attack. Gradually, the symptoms eased up. And slowly, Carolyn was able to start walking again. Carolyn, I thought, you know, this arm pain is really weird.

[00:01:53] Maybe I'll just stop into emergency while I'm walking past the building. Carolyn worked in public affairs at her local hospital. And the emergency department of that hospital was on her route home. So I popped into emergency and right away they brought me in. As soon as you say, I think I'm having a heart attack. I had all the diagnostic tests that would be normally offered to a patient with my symptoms. And all of my tests came back normal with air quotes around normal.

[00:02:22] The ER doctor, by the way, had just diagnosed me with acid reflux. The doctor told Carolyn, go home, make an appointment with your family doctor. You'll get a prescription for antacids. Goodbye and have a nice life. So I was pretty embarrassed that I'd made such a big fuss over nothing but a case of indigestion. But before I left, the nurse came over to take out the IV and other stuff that they'd prepped me with.

[00:02:52] And she gave me this very stern lecture. And she said, you'll have to stop asking questions of the doctor. He is a very good doctor and he does not like to be questioned. And the worst part of this conversation was that I had only asked the doctor one question. And that was, but doc, what about this pain down my left arm?

[00:03:18] Being sent home was a profoundly humiliating experience for me. And not making a fuss is a big thing for me. So I could not get out of that emergency department fast enough. There was no way I was going to go back there when my symptoms resumed, which of course they did almost immediately because I was having a heart attack.

[00:03:46] Carolyn was having what's known as a slow onset heart attack. I wanted to believe that man who had told me he had the letters MD after his name. And he told me, it's not your heart. So when my symptoms resumed, same symptoms, central chest pain, nausea, sweating, pain down my left arm, I knew it wasn't my heart. But I was also able to function. I went to work. I drove my car.

[00:04:13] And I knew, or I thought I knew that if I had been having a heart attack, there's no way that people having a heart attack could drive their cars or go to work or fly to Ottawa. Four days after her heart attack, Carolyn got on an airplane and flew five hours across the country to Ottawa to celebrate her mother's 80th birthday. That whole time, she kept herself going by taking antacids for what she thought was a very bad case of indigestion.

[00:04:43] I had several attacks in Ottawa, but I didn't want to ruin my mother's birthday weekend. So you were at your mom's 80th birthday and then what happened? Then I got on the plane and I flew back home. So as the plane was landing, I had two more attacks on the plane. And then I got into my car and I drove home on the highway.

[00:05:05] So even as I'm saying these words to you, I think, I know this makes me sound like a crazy person, because that's not what you should ever do when you're having these extreme cardiac symptoms. I was thinking, but I wasn't thinking straight. The next morning, Carolyn went back to the emergency room. This time, all the tests showed something was very wrong. They called a cardiologist. And I remember this so clearly.

[00:05:31] He took my hand in both of his hands and he looked me right in the eyeballs. And he said, Mrs. Thomas, I can tell from your T waves and all of your other cardiac tests that you have significant heart disease. I almost fell off the stretcher. Immediately, as soon as he said that, it was as if he started speaking a different language. Like I saw his lips moving. I heard sounds coming out of his mouth.

[00:05:58] But I was so overwhelmed by what he had just told me. Significant heart disease. How could I have significant heart disease when this very hospital sent me home two weeks ago telling me it was nothing? Carolyn's heart attack had a name, the Widowmaker. It's caused by a blockage to the left anterior descending coronary artery. That's the main artery bringing blood to the heart muscle. She had a stainless steel stent implanted into her, which saved her life.

[00:06:28] And afterwards, she was taken to the intensive care unit for heart patients. That's when I started to get mad. Wait a minute. Wait a minute. Wait a minute. What's going on here? And the more I learned, the more shocking everything seemed to me that this is still going on. This is Overlooked, and I'm Golda Arthur. Carolyn Thomas' story is wild, isn't it? But it shouldn't shock us.

[00:06:57] Heart disease is the leading cause of death for women in the United States. It kills more women than cancer does. And this hasn't changed for the last 40 years. What has changed is that fewer women know that and know about the symptoms. Carolyn's story is unsettling for so many reasons. And in this episode, we're going to get into all of them. How doctors treat women with heart disease.

[00:07:23] How we as women shy away from advocating for ourselves in moments like this. And what is it really going to take to change how we all think about heart disease in women? Carolyn Thomas now writes a blog called Heart Sisters, and she's the author of a book, A Woman's Guide to Living with Heart Disease. Carolyn talks about all of this and what happened next for her. That's all coming up in a minute. Stay with us.

[00:07:55] Hey, just a quick word here. If you're new to Overlooked, welcome. This show exists to make sure that no one is overlooked in women's health. And we do that by telling stories like this one. Deeply personal, but also really informative. We try to explain the science clearly, and we center women and the health stories they think no one cares to listen to. But you're listening, and we thank you for that.

[00:08:22] If you'd like to support the work we're doing at Overlooked, please consider joining us on Patreon and becoming a patron of the show. Check out our show notes for more information on that. Now back to the episode. Hi, Carolyn. Welcome to Overlooked. Thank you so much for joining me. Thank you for inviting me to be here today. Can we talk about anger for a minute? Yeah. Are you still mad? No. Anger is very, very bad for heart patients.

[00:08:53] It raises the stress hormones, the cortisol, the adrenaline in your bloodstream, and then it damages your coronary arteries. And I already had damaged coronary arteries, so I was trying very hard just to be calm. And instead of being angry and yelling and screaming, I really threw myself into this sort of research project. Let's find out what's going on. Who's doing what? Does this happen everywhere? How often does it happen?

[00:09:20] And what makes me feel less like an insane person when I tell my story is how common it is for women to delay treatment. Researchers call it treatment-seeking delayed behavior. And there's a whole field of medical researchers who study this, not just for cardiac reasons, but for all kinds of reasons. Women tend to minimize their symptoms. They delay their approach to emergency help.

[00:09:48] I do these free HeartSmartWomen presentations in the community. And I met a woman at one of my talks who said she had very similar symptoms to my textbook, Hollywood heart attack symptoms. It was the morning of Christmas Eve. And her son, she had a grown son who was at home helping her getting prepped for Christmas. And he said, Mom, you look awful. I'm going to take you to emergency. And she said, Honey, I have 12 people coming for Christmas dinner tomorrow.

[00:10:16] I cannot go to the hospital today. So to many women, this sounds normal. Yeah. Carolyn, I want to ask you. There are so many questions that are in my mind now, but I want to start here. You say you're not mad anymore. Is there an emotion that has replaced the anger? There are so many emotions, actually, because this is 2025. And a lot of times I am completely gobsmacked. That might be a better word than angry.

[00:10:44] That this is still happening. And every time there's another study on why are women being misdiagnosed? Why do women fare poorly compared to men? And this is across all areas of heart disease. It's now more that I'm disappointed. I have written over 900 articles over the last 17 years on women and heart disease. That is my obsession. Women and heart disease. I have this little tiny niche interest.

[00:11:13] On the subject of women and heart disease, that tiny little topic of conversation. The fact that this heart attack is called a widow maker, to me, is like, do you need any more proof that medicine is built for men? In our language, in our foundational language of what we call these things, it is skewed towards men. So this is very depressing, Carolyn. How do you keep from being utterly depressed by this?

[00:11:42] I'm not a depressive person, first of all. My children tease me that whenever they say, how are you, mom? I always say, just peachy. And when I was growing up, my dad had this little poem that he would say to people who whine. He'd say, don't tell your friends about your indigestion. How are you? Is a greeting, not a question. It wasn't advice. It was like, this is what you have to do around my family.

[00:12:09] But I think what I have learned from my experience, and I'm only one heart patient. So my experience isn't universal. There are many women who have symptoms, go to emergency, get immediately appropriately diagnosed and are treated and never have another moment's thought. So my situation is unique because, number one, I was misdiagnosed by a man with the letters MD after his name. And that meant a lot to me. Essentially, it's a form of abandonment.

[00:12:37] It took a lot for me, me and many women to seek help. And getting back to the treatment seeking delayed behavior, this is so pervasive that I started wondering, why is it so pervasive? Like, why, what is making women delay doing something that makes sense? If I broke a leg, I wouldn't hesitate before going to emerge and getting a cast put on my broken leg. What is it about heart disease that makes women avoid it?

[00:13:07] And one of the things that the researchers found is that women are more likely to self-diagnose. There's a researcher who is at Harvard, and she studies an even smaller niche than I have. And that is how women speak to emergency department doctors about their cardiac symptoms. I mean, this is a woman who hangs around in emergency departments and observes how women talk to the emergency doctors.

[00:13:35] And she said, I have seen with my own eyes, women argue with the emergency doctor. So for example, if he says, tell me about your chest pain, the women will say something like, well, it's not exactly pain. It's more like just like a pressure or it's an ache or something. So they minimize their symptoms. And if you minimize your symptoms long enough, the doctor is going to say, oh, well, maybe it is a pulled muscle.

[00:14:00] So there are many women who go to emergency or to their family physician first, and they talk themselves out of being appropriately diagnosed. Now, I didn't have that experience. I said flat out, here's why I'm here. I've got these four symptoms that I know. I don't know anything about heart disease, but I know these sound pretty cardiac to me. And even with my symptoms, I was sent home from the hospital. Right, right. Can we talk about cardiologists for a second?

[00:14:28] Are we going to talk about women cardiologists? Because I don't want to sound like I'm, I've written, I've written an article called saying the word misdiagnosis is not doctor bashing. Because when I wrote my book, it was published by Johns Hopkins University Press, which meant that a Johns Hopkins cardiologist had to review the entire manuscript before it went to press. And I was the anonymous cardiologist who reviewed my book. Oh, it wasn't even the book. It was the table of contents.

[00:14:56] I had to submit a table of contents with a rough little paragraph of what I was going to cover in each of the 10 chapters. And one of the chapters, I think it's chapter three, is called diagnosis and misdiagnosis. I don't know whether this cardiologist reviewer was a man or a woman, but I'm thinking it was a man because he said chapter three, the title diagnosis and misdiagnosis sounds like doctor bashing to me.

[00:15:22] Right. So I say this regularly on the show and I've had a lot of doctors on the show as well. So if you're a doctor and you're listening to the conversation we're about to have, we love your profession. We might even love you. We are not about to bash doctors, but if you're a doctor who's listening to the show, I know you have the humility to know that medicine has to change.

[00:15:48] Right. And I think that certainly every doctor I've had on the show and I've had dealings with recently, including my own, they understand that medicine needs to change because the statistics for women and heart health are just, you know, we're all reading the same things. Right. So please don't take this personally, doctors. We love you all. So let's go at it with this point of view. Right. But let's talk about cardiologists. Right. And I'm excited to talk about women cardiologists because I think this might.

[00:16:18] Be sort of an interesting little corner that I don't know enough about. So you probably know more cardiologists than I do. Carolyn, tell me, is cardiology changing? How do they look at this issue of women and heart disease? Well, I'm not a cardiologist, so I can't speak for cardiologists, but I've met many, many, many and many follow my blog and have read my book and have spoken to medical conferences.

[00:16:40] So I've met a lot of cardiologists and there's some really fantastic things that are happening in cardiology that have not happened before. First of all, only 12 percent of all cardiologists are women. So it's been called an old boys club. And for a long time, women were not treated the same way by their peers.

[00:17:01] And then just recently, I would say in the last 10 years, I have noticed that there seems to be this movement from young female cardiologists. These are young women just out of medical school. They're doing their cardiology residency. There's a very loose organization called WIC, W-I-C, Women in Cardiology. It's based in the States.

[00:17:25] And they're always on social media talking about some fantastic research that they're involved in or some fantastic findings of a recent emerging study. So I love reading and hearing and meeting these young WIC cardiologists because this is the way of the future.

[00:17:44] If you have a doctor, here's where I'm treading on kind of shaky ground here because I don't want to say all white male cardiologists have a certain mindset. But we have some very troubling results in the field of women's heart health. There's a lot that's been written in the last decade about this implicit bias. One of my favorite stories, and when I say favorite, I don't mean I like it.

[00:18:14] I mean, this takes the cake kind of favorite. A large study that was done in the States on ambulance drivers. This is a brilliant study because it's just data. Just data. They get into their ambulance. They get a call. Immediately, they have a little laptop attached to the dashboard.

[00:18:35] They enter in the date, the time of day, the nature of the call, the address, the name of the person who needs help, including did we give this person an IV? Did we give them anything en route to the hospital? Did we take them to the hospital? So they have to detail every detail in their laptop, including whether or not they put flashing lights on and put on their sirens on the way to the hospital.

[00:19:03] And the study found that, based only on this data, years of data, that if a woman called 911 and said, I'm having these heart symptoms, I think I'm having a heart attack. If that woman was in the back of the bus, as they say, the driver of the ambulance was significantly less likely to use flashing lights and sirens on the way to the hospital, compared to if a male patient was in the back.

[00:19:34] Now, how do you explain that? One of my readers told me recently that when she went to the hospital, the doctor said to her, I think we both know what's going on here, don't we? And then he prescribed anti-anxiety medication. Oh, my God.

[00:19:57] So when you hear things like that, it's hard to say, boy, we're really making inroads into more successful practice of medicine when women are involved, as long as you've got this implicit bias. And there are a couple of books that I usually warn people, don't read them until you've taken your blood pressure medication. You will throw this book across the room, believe me. One is Maya Dusenberry's classic book called Doing Harm. Yes, fantastic book. Yep.

[00:20:25] And it's actually the evidence that she outlines in there is quantitative and it's undeniable. And in fact, this line that I say quite regularly that medicine is built for men, when I finished reading it and I put it away, that's when that line first came to me. And, you know, again, that is not men bashing, that line. It is just we live in a system and this is how it is. Like, this is how the origin story of medicine came about.

[00:20:53] And this is its legacy that we're still dealing with. And what is at stake here is life or death for women. I mean, is it not as simple as that, Carolyn? It's that simple. Yes. We don't need to make it more complicated because when we have studies, like you said, when you have a quantitative study, like the ambulance study, there's no arguing with that.

[00:21:16] So, OK, if you're listening to this and I think regardless of who you are when you're listening to this, I think you can't help but come away from this conversation being either very shocked or, as you say, disappointed or like me, just really, really angry. And anger is useful for me for the short term because it clarifies my thoughts, for example. And then I always say to myself, I need to turn this anger into something else.

[00:21:44] And actually, this podcast exists because I was like, wait, how come we don't know anything about ovarian cancer or I don't know the ovaries themselves? So what do you say to people who are listening to this, whether they are men or women, who are thinking to themselves, this makes me really mad. What should happen next after that anger? Like, what do we do, Carolyn? I know. That's what I've been asking, too. What do we do? And let me answer that with what sounds like a sideways thing.

[00:22:12] But when we focus on heart issues, does that help to educate anybody about what we're talking about today, which is this undertreatment, underdiagnosis of women heart patients? No, it doesn't.

[00:22:30] A couple of years ago, the American Heart Association did its national survey, which they do every 10 years, specifically asking women about how aware they were of heart disease, which is their number one killer. And the results were so shocking to me personally that I had to stop writing my blog articles for Heart Sisters.

[00:22:55] I couldn't even get up in the morning, practically, because what they found was that women's awareness was worse now than it was 10 years earlier. Even the American Heart Association admitted that this was a lost decade. So imagine this. One of the temptations for me as a blogger and as an author is if I think women don't know this, I'll tell them. I'll give them some information.

[00:23:21] And what we believe intuitively is that when people don't do things that are good for their health, it's because they don't know stuff. And if I can tell them the stuff, they'll get it and then they'll do it. Well, if that were true, there would be no anti-vaxxers because they've been loaded with a ton of data and information and research evidence. And it doesn't matter. And that's also the issue.

[00:23:47] Heart disease, to me, did not matter to me until it happened to me. I'm pouring out this information every Sunday morning. There's a new article about something that has to do with women and heart disease. I've been doing this for years because I had this belief that all I had to do is give this information. Oh, look at the study. This study is so interesting. Wait till women read this. This will really make a difference.

[00:24:14] And then I read the American Heart Association survey results and it turns out it's worse now. So that makes me feel like, are we going backwards? Whatever we're doing, whatever I'm doing as a private person who's churning out these articles and writing a book and totally obsessed with this subject and obsessed because of the anger that I felt first. This is not right. This is not right. What can we do about it?

[00:24:43] I had to come to grips with the fact that whatever I'm doing is not working. And that was so staggeringly hard for me to cope with. So when you ask, what is the next step? Honestly, I don't know if there's another step. Sometimes I look at medical students and I think this is our hope. It's these young, keen women.

[00:25:11] Again, I don't want to say that male medical students are not just as informed and keen and willing to learn new things. But I'm so impressed by this group of practicing cardiologists who are all women. And I think, I think they're on the train. You know, the train is moving. Although, you know, if only 12 percent of cardiologists are women, then it's really we need to see change from this new generation of male cardiologists. Right. We have to put our hope in them as well because they are the majority.

[00:25:41] They're the guys who are going to be saving our lives. And I have a male cardiologist who I am in love with. So I would never trash male cardiologists because I've got like the best one. But this is a systemic problem. It is a systemic problem of how women are raised, how we're socialized to behave. Things like not making a fuss.

[00:26:15] I want to start to draw us to a close here. We've touched on this already, but the challenge here is I'm going to ask you to distill it in one answer. And the question is, what has been the most overlooked aspect of what we're talking about, women and heart disease? And where is that inequality felt most deeply, do you think? I'm going to quote Dr. Sharon Hayes, who is the founder of the Mayo Women's Heart Clinic in Rochester, Minnesota.

[00:26:43] And as she once told me, men don't have to beg to be believed by their doctors. And women do. Again, getting back to the socialized problem, the way women respond, the way women are treated, the way women are believed or not believed. I would say, though, I want to speak now to women who might be in a situation one day where you are like me and you feel these really weird symptoms.

[00:27:11] You know your body. You know your body. You know when something is just not right. And if you feel that way, then ask yourself, what would I do if these same symptoms were happening to my daughter or my mom or my sister? And then do exactly what you would do for those people you love. Because women are sometimes our own worst enemies. And researchers tell us this.

[00:27:38] Women are more likely to apologize to emergency staff for bothering them, for coming in when it's not necessary. They minimize their symptoms and say it's probably nothing. They self-diagnose. Now I tell the women in my audiences, tell the doctor your symptoms and then shut up. Right. So that systemic change should begin with us in a way. And, you know, personally, I'm a real pain in the ass to any given doctor.

[00:28:06] And I know that all my doctors will attest to that because I ask far too many questions. So if you're like me and you're a real pain in the ass to your doctor, then just find a doctor who really thrives on being sort of in collaboration with a patient. And I think last time we chatted, we were talking about Jerome Grutman's book. He's a physician who wrote this book called How Doctors Think. Such an important book.

[00:28:30] And he has three little questions that if you're being diagnosed and it doesn't sound right, doesn't feel right, I don't think that's what that is. He says, ask these three little questions. Number one, what else could it be? Number two, is there anything that doesn't fit? I wish I'd asked my eMERGE doc that because certainly pain down your left arm does not fit with indigestion. And number three, could I have more than one problem? I could have anxiety and a heart attack at the same time.

[00:28:59] I often tell my audiences that there are few experiences in life that are more anxiety producing than being in the middle of a freaking heart attack. Carolyn, I've kept you for a very long time. This has been an absolutely fascinating conversation. I know you're sort of sitting there wondering, is anybody listening? Is any needle moving through my work? And I want to say that absolutely it is. So please keep doing what you're doing. So thank you so much for being on Overlooked. Thank you very much for asking me. It's been a great chat, really.

[00:29:32] We're building a community around women's health so that no one is overlooked. If you'd like to be part of it, hit the follow button on this podcast wherever you're listening to this. Or you can show us some love by writing us a review and sharing this episode with someone. Overlooked is written and created by me, Golda Arthur. Jessica Martinez-Dijos is the show's producer. You can stay up to date with the show by signing up for the newsletter. And following us on Instagram and LinkedIn.

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