Heart attack portrayals in movies miss the mark, study finds

In the 2003 movie, "Something's Gotta Give," Jack Nicholson's character, Harry, is seen rolling on the floor, clutching his chest and sweating profusely, barely able to speak while his eyes roll back in his head. Asked if his chest hurts, he gasps, "It's like an elephant's … sitting on it."

Welcome to heart attacks, Hollywood-style.

According to a new study, the film industry overwhelmingly portrays heart attacks in precisely this manner: white men, clutching their chests and collapsing. Women and people from underrepresented races and ethnicities are rarely seen having heart attacks on the big screen, nor are the typical symptoms of a heart attack – which are often much more subtle – accurately portrayed.

The findings, published Wednesday in the Journal of the American Heart Association, suggest the movie industry is contributing to public misconceptions surrounding heart attacks – and how they affect anyone other than white men.

"Given the crucial role popular media plays in shaping public understanding of health issues, this lack of representation could be contributing to the misunderstanding that cardiovascular disease is a man's disease," said the study's lead author, Dr. Kirsten Shaw, a cardiology fellow at Allina Health Minneapolis Heart Institute in Minnesota.

"In reality, heart disease is the No. 1 killer of women in the U.S. and disproportionately affects racial and ethnic minority populations," she said. "But they aren't seeing themselves represented in popular media."

In fact, just 44% of women recognize heart disease is their leading cause of death, down from 65% in 2009, according to a 2019 American Heart Association survey. Awareness is lower among Black women, who are at higher risk of dying from heart disease than their white peers but largely unaware of the symptoms of a heart attack.

The drop in awareness two decades after the AHA launched a campaign for women is what inspired Shaw and co-author Dr. Retu Saxena, a cardiologist at the institute, to investigate.

"It's been 20 years since Go Red for Women started, and yet the awareness among young women – and especially women of color – that heart disease is the No. 1 killer of women is decreasing, not increasing," Saxena said. "It's glaring to me."

Cardiovascular disease includes all conditions that affect the heart or blood vessels, including heart disease and stroke. In the study, Shaw's and Saxena's team focused on heart attacks, which can be caused by heart disease. Using the search term "heart attack," the team reviewed 172 top-ranked movies from the U.S. and around the world. They identified scenes from 83 U.S. and 17 international films from 1932 to 2022 in which actors portrayed having a myocardial infarction, the medical term for a heart attack.

Of 100 scenes analyzed, 90 depicted men and 10 depicted women. Overall, 94 of the actors portraying heart attacks were white, including nine women. None of the women were Black.

The two most prevalent signs shown on screen were falling to the ground and losing consciousness, which the authors note may occur during a heart attack but are uncommon. All 10 women and 88% of the men in the films fell while experiencing a heart attack, while 88% of the women and 68% of the men lost consciousness.

Half of the women and 67% of the men were portrayed in the analyzed scenes having chest pain. Four of the women screamed or yelled, compared to 26 men. Half the women and 63% of the men clutched their chests.

These are overly dramatic portrayals of symptoms a person having a heart attack would likely experience, the authors said. In reality, while chest pain is a common symptom for both men and women, women's symptoms are often more subtle. They may feel discomfort in the center of the chest that lasts a few minutes or goes away and comes back, pain or discomfort in one or both arms, the back, jaw, neck or stomach. Other symptoms may include shortness of breath, breaking out in a cold sweat, nausea or lightheadedness.

"The film industry doesn't know how heart attacks are experienced in real life, and they tend to be overdramatized," Shaw said. Many people don't know that there can be more subtle symptoms, such as jaw pain or shoulder pain, she said. "Women can have even more subtle symptoms, such as abdominal pain, but it probably doesn't make a good movie to show those symptoms."

Erika Livingston had no idea what a heart attack might look or feel like when hers occurred three years ago at the age of 41. She worked out regularly and considered herself physically fit. During a hiking getaway with friends in Oklahoma, Livingston noticed she was suddenly having a lot of trouble catching her breath. The shortness of breath continued to bother her at the gym and during simple daily tasks, like walking to the store. She brushed it off as a sign she needed to increase her cardio workouts and thought she might be coming down with the flu.

Then one morning, Livingston woke up with severe chest and back pain. But what concerned her most was feeling freezing cold while sweating so much her bathroom floor was getting wet.

"That's when I started freaking out," she said. "I had no idea it was a heart attack. I was ignorant as to what a heart attack symptom would be for a woman – or for anyone."

Livingston's reaction was not unusual, said Dr. Ruchi Kapoor, a cardiologist and clinical assistant professor at UW Medicine Heart Institute in Seattle.

"A lot of women are surprised when they get diagnosed with heart disease," said Kapoor, who was not involved in the new study. Not only do women think heart disease only happens to men, but when they experience symptoms like back pain, chills and sweating, they don't understand the problem is coming from their heart because "they don't think of that as having a heart attack. They think a heart attack is somebody keeling over and dying. Hollywood is helping to perpetuate this myth in women's minds."

Kapoor said another common misconception perpetuated in films and other popular media is a blurring of the lines between a cardiac arrest and heart attack. "Somebody dying suddenly from cardiac arrest is not the same thing as someone having a heart attack. There's a very big difference between the two."

Cardiac arrest occurs when the heart suddenly stops beating. When this happens outside the hospital, it is nearly always fatal if the person doesn't receive immediate care. A heart attack occurs when blood flow to the heart is blocked, which can cause heart muscle to die. A heart attack sometimes can lead to cardiac arrest but is typically treated by restoring blood flow to the heart.

Saxena said the only realistic portrayal of a heart attack in popular media that she can recall seeing was during an episode of the television show "Grey's Anatomy," which was not included in the study because it wasn't a film. In the 2018 episode, "(Don't Fear) the Reaper," Dr. Miranda Bailey, a Black woman, experiences nausea and heartburn and quietly rubs her chest while getting her child off to school. She then has her husband drop her off in front of a hospital on his way to work, walks in and announces that she is having a heart attack.

When her electrocardiogram appears normal, none of the doctors take her seriously and imply she is feeling stressed, ignoring her demand for additional testing and going so far as to bring in a psychiatrist to speak with her.

"My secret heart doesn't need fixing, my actual heart needs fixing," she insists. "Apparently your teachers didn't get the memo that women's heart attacks don't manifest the way they do in men. They're not all chest-clutching, vomiting, 'Help, my arm is numb!' Boom! Floor drop."

Bailey, portrayed by Chandra Wilson, spends hours in the hospital arguing her case before she is finally allowed a procedure to open her arteries, but only after the blockage nearly kills her.

"That," Saxena said, "is a very accurate portrayal of a woman having a heart attack."