A month before actress Carrie Fisher died due to complications from a heart attack, a staff writer for Great Britain’s daily newspaper, The Guardian, said in an article that his in-person interview with Fisher had to be canceled and had to be done by phone later because she “fell ill.”

But Dr. Ellie Mueller, a cardiologist and director of the Rockwood's women's health, thinks Fisher may have been in the early stages of experiencing the onset of a heart attack and didn’t know it.

Mueller says that heart attacks and heart disease are more commonly associated with men, but statistically, “Women die from heart disease more than men.”

Nationally, one out of three women will die from a heart attack or heart disease, compared to one in four men, says the Centers for Disease Control and Prevention. Despite increases in heart disease awareness over the past decade, only 54 percent of women know that heart disease is their No. 1 killer, the CDC says.

The Spokane Regional Health District says that in 2015, 241 women per 100,000 in Spokane County died of major cardiovascular diseases, making it the leading cause of death.

In the CDC’s most recent reporting year, 2013, it says the leading cause of death for women in the U.S. is heart disease, at 22.4 percent. The second leading cause of death among women is cancer, 21.5 percent, followed by chronic lower respiratory diseases, 6.1 percent; stroke, 5.8 percent; and Alzheimer’s disease, 4.6 percent.

Mueller says it’s her opinion that even most of the medical community in the U.S. isn’t aware of the fact that heart disease is the leading cause of death among women.

 “I’m a plumber. I remove cholesterol plaque and insert balloons and stents to prevent heart attacks,” Mueller says of her job as a cardiologist.

As director of Rockwood's women's health, Mueller spends a day to two days per week reviewing the results of patient blood screens. 

Mueller sees patients at Deaconess Health and Education Center, at 910 W. Fifth. She also treats patients at the Rockwood Clinic facility at 1414 N. Houk, in Spokane Valley.

Mueller says she hasn’t tallied the number of screenings she’s done but estimates she’s performed more than 1,000. She conducts screenings on women from across the Inland Northwest, including Washington, Idaho, Montana, and Oregon, she says.

Dr. Rachel Le is a cardiologist with Providence Spokane Cardiology. She says women are still functional in early and later stages of a heart attack.

“There’s less suspicion of a heart attack because women can remain very active during the onset of heart attack and heart disease,” Le says.

Heart attack symptoms in women also can include neck and jaw pain, as well as feeling like they’re suffering from indigestion, she says.

“There are a lot of quandaries that make our job harder as cardiologists as it relates to women,” Le says.

Mueller says education and awareness are important for women. After conducting patient screenings, she follows up with them to share information of the results.

“Feeling ill,” according to Mueller, is a common symptom women experience before and during a heart attack.

Mueller says the difference in heart attack symptoms between women and men is due to physiology.

Women have smaller arteries throughout their bodies than men. For example, the right coronary artery in a man is three to four millimeters in diameter compared to two to three millimeters for a woman. Smaller arteries clog faster, she says.

“Most men will get the classic, crushing interior chest pain. Women, unfortunately, hardly ever get that chest pain. We get flu-like symptoms, nausea, experience fatigue, body aches, mild shortness of breath—the general just not feeling well,” Mueller says.

It’s those symptoms, according to Mueller, that send women to urgent care clinics or their primary physician, not to the emergency room to see a cardiac specialist.

“We’re obviously different, and the same thing applies to our health and heart disease,” Mueller says of the difference between men and women.

“Not only are our arteries smaller in diameter, but they’re also reactive, meaning they spasm more,” she says. “We respond to life events and stress differently than men. A combination of these things play a role when it comes to heart attacks, heart disease, and strokes.”

Regarding strokes, Dr. Ken Isaacs, a neurologist at Providence Sacred Heart Medical Center, says symptoms in men and women can be different, though physical signs tend to be consistent.

Facial drooping, weakness in one or both arms, and slurred speech occur in both women and men. Diabetes, hypertension, and smoking all have the ability to contribute to having a stroke, he says.

Mueller says it’s critical for women to be in tune with their bodies.

Simple preventive measures include a healthy diet, exercise, and smoking cessation, she says.

The American Heart Association and CDC also say women who drink alcohol should limit their intake to an average of just one drink per day. Finding healthy outlets to manage stress also can reduce the risk of heart disease.