"Since Richard Steingart wrote his 1988 paper (in the "Annals of Internal Medicine") about how some cardiologists are more likely to dismiss cardiac symptoms more frequently in women than in men, the cardiovascular community has responded positively to the information about women and their experience with heart disease. The paper stimulated a period of intensive research into how women experience coronary artery disease. It has been a slow but rewarding process to educate primary care physicians about the new information."

Does the New Information Work in Practice?
Hipkins was properly given cardiac catheterization, a test to find out how well her blood vessels work and then was sent home from the hospital despite continued chest pain. Although she was taking her newly prescribed Nitrostat, Hipkins still suffered pains in her arm and chest and could not walk more than a block.

She went for a second opinion. That doctor evaluated her symptoms and accused Hipkins of having problems "in her head." But what Hipkins was experiencing was angina, a serious medical condition that causes significant pain.

Angina pectoris is caused by an insufficient supply of oxygen to the heart muscle, usually after exercise or stress. Angina usually precedes a heart attack and is almost always due to atherosclerosis. But there is another kind of angina, called Prinzmetal's variant angina, which is not related to plaque build-up on the coronary arteries. Instead, it is caused by a spasm of a coronary artery and may occur at rest, or at odd times during the day or night, and is more common in women under age 50.

Angina can be detected with an angiogram, an exercise stress test, or an echocardiogram (a non-invasive, ultrasound exam that measures the size and function of the heart). Angina may be treated with drugs, an angioplasty (a surgical procedure where a very small balloon is inserted into a blocked artery to increase its diameter), or artery bypass surgery.

Hipkins had now been in cardiac rehabilitation for eight weeks, was missing work, and in desperation, visited Dr. Elizabeth Ross at Washington Hospital Center in DC. It was two years before Dr. Ross would publish her book about women and heart attacks.

Hipkins recalls that Ross said to her, "We don't understand all the dynamics of heart attacks and angina in women at this time."

In tears, Hipkins returned to her own doctor. She had no job, no sex life, and chest pain when she drove her car. Her doctor experimented with medication in the hope that he would find the right combination to restore her quality of life.

On her own, Hipkins tried acupuncture, and found she could then take long walks. She discontinued her medications after a year out of concern for eventual liver damage, but continues her acupuncture treatments, and is now an acupuncture practitioner.