Many women are oblivious to their grave risk for heart disease.
They have no idea what heart-attack symptoms would feel like.
They ignore the danger signs and carry on.
They delay going to the emergency room until it's too late.
And then, to make matters worse, they frequently receive substandard care.
That's the problem. You would think that Debbie Smith, a registered nurse at Kent County Memorial Hospital in Warwick, R.I., might have been an exception.
But the myth that women do not get heart disease is entrenched in our society.
And Smith, like so many others, ignored her early symptoms. She just went to work one Saturday in the midst of an episode.
She did ask another nurse to check her blood pressure, saying, "I feel like my head is going to blow up. It's like a vice grip, tightening and tightening."
Later that day, when her sudden, severe headache continued along with a drastic rise in blood pressure, she called her doctor. The physician's assistant on duty told her to take Excedrin Migraine, and to call the doctor on Monday.
After suffering all weekend, she did just that.
Over the next five weeks, she had a battery of tests, including an MRI. Doctors hypothesized that she had either multiple sclerosis or a rare kidney tumor.
Her ordeal began with a symptom typical of women's heart disease: a general malaise.
"It was nothing I could pinpoint. I didn't feel great, so I went back to bed, which I rarely do," she says.
She awoke with pain that she thought was indigestion. Later, her symptoms became more traditional. The pain moved from her abdomen to her chest, she became sweaty, and she had trouble breathing.
Smith, 49 at the time, called out to her daughter: "You have to call Daddy and then call 911, because I think I am going to die."
The emergency technicians administered aspirin and nitroglycerin before taking her to the hospital.
By the time she arrived, she was symptom-free and feeling foolish for being there. And because her cardiogram and her blood work were normal, her health-insurance company refused admission. Her physician kept her overnight for observation, and called in a cardiologist.
Smith was also in denial. Even though she lay in the cardiac unit hooked to machines that monitored her heart, she rejected the notion of a heart attack. She attributed the numbness in her left arm to carpal-tunnel syndrome.
Smith was released with instructions to get a stress test, which took weeks to schedule. Five minutes into the test, she had to stop. She was having trouble breathing. The test showed her heart wasn't getting enough blood.
The cardiologist summoned her to his office. Reality was setting in, Smith says: "It's never a good call that the doctor wants to see you."
He told her that she had blockage in her heart, and he had already scheduled her for cardiac catheterization.
The blockage could not be removed. An angioplasty specialist was added to the team, and, three days later, he cleared a small block and inserted a stent.
Smith avoided a heart attack and has no heart damage.
"I was probably lucky that the rescue guys gave me nitro, because it may have gone further. I may have had a heart attack if they hadn't done that," Smith says.
Knowledge about heart disease in women simply has not been available because women were excluded from early heart research.
Over the past decade, new studies have revealed that women's heart attacks manifest in unique and subtle ways. Also, it's been learned that women's risk factors are different.