Heart disease is the number one cause of death for women in America. Unfortunately, for many women it often goes mis- or undiagnosed. For example, myocardial infarctions (that is, heart attacks) are often more subtle in women than men, and can present with symptoms like fatigue, nausea, and shortness of breath instead of the stabbing chest pains men experience. Now, however, cardiologists are starting to make some progress toward gender parity.
Four of the world’s leading heart health groups, including the American College of Cardiology and the American Heart Association, agreed on major changes to the definitions of myocardial infarctions, which were announced during the European Society of Cardiology’s annual congress in Germany.
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“People may think of an MI as a heart attack caused by a blocked coronary artery, but there are many different causes of MI,” explained ESC Chair Nicholas Mills in a statement. “The previous universal definition used a numerical system to categorize the different types of MI, but this wasn’t always easy to apply in clinical practice, leading to inconsistencies in diagnosis and treatment.”
The new classification system ditches numbers and designates myocardial infarctions as primary, secondary, and procedure-related, outlining the specific tests and investigations required for each. Primary MI (your traditional heart attack) occurs spontaneously, usually as a result of an arterial blockage caused by the rupture of plaque. Secondary MI results from an imbalance in the heart’s oxygen supply and demand that’s caused by another condition (like tachycardia or abnormal blood pressure). Finally, as the name suggests, procedure-related MI pops up within 30 days of a cardiac procedure or surgery.
Importantly, the definition of primary MI now also includes several less common heart-attack triggers that disproportionately affect women. Heart attacks caused by spontaneous coronary artery dissection (a tear in the wall), coronary artery spasm (a tightening of the vessel), and coronary embolism (a wandering blood clot or fat globule) are all designated as primary MI under the new rules.
This more serious designation comes with more serious investigative methods. For example, primary MIs should now also be confirmed with an angiogram, which can help determine the specific cause so the proper course of treatment can be taken.
"For decades, women have missed out on accurate diagnoses and treatment,” chief scientific and medical officer of the British Heart Foundation Bryan Williams said in a statement on the new rules. “This focus on finding less common causes of heart attacks, which predominantly affect women, should help to change that. It could be life-changing for huge numbers of women in the U.K. and worldwide.” 
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