WHEM 2026 Conference Highlights
- alexoverem
- 3 days ago
- 9 min read
Updated: 2 days ago
Sex-Specific Strategies in Emergency Department Cardiac Care
On April 29th, clinicians and researchers in women's cardiovascular health gathered for a full day conference on Sex Specific Strategies in Emergency Cardiac Care. The program brought together cardiologists, emergency physicians, pharmacists, epidemiologists, nurses, EMTs, and community health advocates to cover a range of topics — from the pharmacokinetics of antiarrhythmics in pregnancy to the maternal mortality crisis facing Black women — with a shared focus on what the current evidence means for emergency practice. Here are the highlights.
Alyson McGregor, MD, MA, FACEP, founder of the Division of Sex and Gender in Emergency Medicine at Brown University, delivered the keynote address challenging gender assumptions that persist in our medical education today. She illustrated how even widely accepted clinical decision tools, such as the HEART score, can underestimate risk in women. Dr. McGregor traced these disparities to the historical exclusion of women from clinical research—from the 1974 National Research Act excluding women, to the FDA's 2016 requirement that researchers account for sex as a biological variable. Although policies have changed, she argued that their legacy remains embedded in everyday practice through biased datasets, clinical decision tools, and pattern recognition models built largely around male physiology.
“We really need to stop using the word atypical for how women present—that's only atypical when you're looking at it with male as the standard.”
Practical Pearls:
Use sex-specific troponin thresholds — 14 ng/L for women vs. 22 for men, FDA-approved since 2017 and still underutilized in many institutions
Women are twice as likely to experience adverse drug reactions — consider whether your dosing assumptions were derived from studies that included them
Estrogen receptors exist throughout the body — in the heart, brain, skin, and bones — meaning hormonal status is relevant far beyond obstetrics and gynecology
Ask yourself at the bedside: would I be more concerned if this patient were a man?
Nisha Parikh, MD, MPH, cardiologist and director of Northwell's Women's Heart Program, dove into cardiovascular phenotypes that are unique or more common in women. MINOCA, SCAD, coronary vasospasm, microvascular dysfunction, and Takotsubo cardiomyopathy together account for a substantial proportion of cardiac events in women — events that a normal angiogram will not explain and that a treatment algorithm built around plaque rupture will not address.
"There is really a power to just getting a diagnosis for these patients. You've probably seen them coming into the ER really frequently and not knowing what's wrong with them — it frustrates everyone."
Practical Pearls:
A normal angiogram is not the same as a normal heart — 25% of women's MIs involve non-obstructive coronary disease
Ask about obstetric history in every female cardiac patient — preeclampsia, gestational diabetes, and preterm delivery are cardiovascular risk factors that persist for decades
If you have a mammogram in the chart, look for breast arterial calcification — it is a no-cost cardiovascular risk marker that requires no additional testing
Takotsubo cardiomyopathy occurs in 90% of postmenopausal women and is triggered by emotional stress — consider it in the differential for any postmenopausal woman presenting after an acute stressor
Send your frequent-flyer chest pain patients with normal caths to a center with coronary function testing capability — vasospasm and microvascular disease are diagnosable and treatable
William Heuser, MS, PharmD, clinical pharmacist and critical care flight paramedic, reassured us that in pregnant patients with serious arrhythmias, the danger is less about choosing the drug, and more about the hesitation. With cardiovascular disease now the leading cause of maternal death and arrhythmia hospitalizations in pregnancy trending upward, providers cannot afford to be paralyzed by fear of fetal harm.
"The care of a pregnant patient with hemodynamically significant arrhythmias should not be compromised by fear. Healthy mom is healthy baby — restoration of normal perfusion is the priority."
Practical Pearls:
Cardiovert the unstable pregnant patient — electrical cardioversion is safe in all trimesters and hesitation is the real risk
Adenosine is safe in pregnancy but requires higher doses due to increased adenosine deaminase activity
Metoprolol and propranolol are your first-line beta blockers in pregnancy — avoid atenolol due to its long half-life
Lidocaine is the preferred agent for ventricular arrhythmias in pregnancy — it crosses the placenta but is rapidly metabolized and does not accumulate
Amiodarone is last-line, not first — reserve it for refractory cases only
Always ask why the arrhythmia is happening — thyroid storm, PE, and electrolyte disturbances from hyperemesis gravidarum are common reversible causes
Women with a known SVT history who are planning pregnancy should be referred for ablation before conception — recurrence during pregnancy is ten times more likely without it
Jennifer Mieres, MD, FACC, MASNC, FAHA, cardiologist and senior vice president of health equity at Northwell, helped us zoom out to the systems level. CVD remains the leading cause of death in women, death rates are rising again after decades of decline, and projections through 2050 are, in her word, a tsunami. But the data that landed hardest was local: a woman who survived a PCI only to return in STEMI because she had not understood her discharge instructions — not because she didn't speak English, but because she thinks in Spanish, and no one had asked.
"We have to go beyond our scientific journals and become storytellers to help women translate knowledge into action."
Practical Pearls:
Measure your door-to-evaluation times by sex — if you aren't tracking it, you can't fix it
Confirm preferred language of cognitive processing before any high-stakes discharge conversation — a patient may understand English but think and process information in another language
"Have you recently been pregnant?" should be a standard ED intake question — it is not routinely asked and it changes management
The ED is one of the most underutilized cardiovascular prevention touchpoints in medicine — many high-risk women presenting for any reason have never had a risk conversation with any provider
Social determinants of health are not background context — they are pathophysiology, driving chronic inflammation and cardiovascular disease progression
Lance Becker, MD, FAHA Chair of Emergency Medicine at Northwell Health and a leader in resuscitation science, brought four decades of disparity research into focus. He reflected on his early work in Chicago, which revealed cardiac arrest survival rates far lower than national estimates and disproportionately high rates among younger Black patients. While outcomes have improved, important gaps remain. Women are still less likely to receive bystander CPR, experience longer delays to defibrillation, and receive advanced therapies after cardiac arrest. These disparities persist even in countries with universal healthcare. He closed by flagging an emerging frontier: sex differences in mitochondrial biology that may one day reshape how we approach resuscitation differently for men and women — a reminder that the science of disparity is still being written.
"Both men and women are less willing to do CPR on women...these are real issues. And they are areas of great opportunity."
Practical Pearls:
Women receive bystander CPR less often than men, with modesty concerns consistently cited as a barrier — this should be explicitly addressed in any community CPR training your department supports or promotes
Defibrillation delays for women in out-of-hospital arrest are measurable and addressable — if your system isn't tracking response metrics by sex, advocate for it
Erica Spatz, MD, MHS, Associate Professor of Cardiovascular Medicine at Yale and director of Yale's Preventive Cardiovascular Health Program, talked about the women who are falling through cracks in our standard cardiac workup. The Virgo study of young women post-MI found that one in five had no identifiable plaque rupture, and one in eight had no explanation at all — yet these women were returning to the hospital at higher rates than men in the year after their event. A separate study by Dr. Harmony Reynolds added another layer: among women presenting with MINOCA, roughly 38% had by IVUS actually had a conventional plaque-based MI whose thrombus had dissolved before anyone looked — meaning they went home without dual antiplatelet therapy or statins. Dr. Spatz also shared qualitative research from her own center, in which women with undiagnosed chest pain described years of cycling through the healthcare system without answers — some forced to take medical leave, others leaving careers entirely — and the profound relief that came when a diagnosis was finally made, even an imperfect one. Her message to emergency physicians: a prior normal angiogram does not rule out conventional MI, and a woman who keeps coming back deserves escalation, not reassurance.
"We need to listen better, with less dismissal of symptoms when traditional diagnostic criteria doesn't add up."
Practical Pearls:
A prior normal angiogram does not rule out conventional MI — without IVUS, a significant proportion of women labeled MINOCA may have had a plaque-based MI whose thrombus dissolved before angiography
When a woman returns to the ED repeatedly with chest pain and no diagnosis, that is a signal to escalate the workup, not to reassure
Diabetes and smoking confer disproportionately higher cardiovascular risk in women than in men — weight them more heavily in your risk assessment
Preeclampsia confers up to a fourfold increased cardiovascular risk that persists for decades — it belongs in every female cardiac history
Women with endothelial dysfunction get chest pain with sudden exertion because their arteries haven't warmed up — counseling them to warm up before exercise can reduce symptoms and ED return visits
Molly McCann-Pineo, PhD, MS CPI, EMT-B, clinical epidemiologist and director of emergency medicine research at Northwell, trained the lens on a population most emergency physicians don't think of as patients: their own colleagues. Female EMS clinicians are working in one of the most cardiovascularly hostile occupational environments that exists — shift work, chronic trauma exposure, physical strain, poor nutrition access — and 75% of them stay on the ambulance during pregnancy. In her research, one in four developed a cardiac condition during pregnancy, and 40% came to the ED for care.
"These women are coming through your doors. That is a huge opportunity to have conversations about risk — not just for EMS clinicians, but for any woman in a high-stress occupation."
Practical Pearls:
High-stress shift work is an independent cardiovascular risk factor — relevant not only to EMS but to nurses, residents, and ED staff
Ask female first responders of reproductive age about their cardiovascular risk and whether they are planning pregnancy — many have never had this conversation
The occupational hazards of EMS work during pregnancy — heavy lifting, infectious exposure, physical strain — are associated with elevated risk of preeclampsia, preterm labor, and miscarriage; if a pregnant EMS clinician presents, her occupation is part of her risk profile
Natassia K. Harris, DNP, RN, IBCLC, founder of the Perinatal Health Equity Initiative, delivered a talk that grounded the day's statistics in the lived reality of the women and families most affected. She presented national and state-level maternal mortality data showing that Black women die at disproportionately higher rates than other groups, that the majority of those deaths occur in the postpartum period, and that upwards of 84-90% are deemed preventable. Central to her talk was a challenge to the way clinicians frame risk with their Black patients: the commonly cited individual risk factors — poor diet, late prenatal care, obesity — place the burden of blame on the mother, obscuring the systemic and structural forces that produce those conditions in the first place. When we lead with those factors in our clinical conversations, we risk alienating the patients who most need our care and deepening a well-founded distrust of the healthcare system that is both historically grounded and clinically consequential. How we talk about risk with our patients matters as much as what we know about it.
"You are at risk as a Black woman because of your proximity to racism, not your genetic makeup."
Practical Pearls:
"You are not an expert in that woman's body. She is the expert on her lived experience."
Ask every patient who presents to the ED: "have you recently been pregnant?" — postpartum complications can present up to a year after delivery
Believe the blood pressure reading on the first try — retaking it to get a more comfortable number delays treatment
A rise of 30 mmHg or more from a patient's personal baseline is clinically significant even if the absolute value appears normal
Black women often show facial, hand, and foot edema before blood pressure changes — do not normalize swelling as a routine pregnancy symptom
Educate partners and family members on post-birth warning signs at discharge — the patient may not self-advocate, but her support system can
Multidisciplinary Panel — Cardiac Arrest in Pregnancy
Alexis Schembri-Owens, MD, EMT-CC
Tania Herrington, EMT
Giuseppe Saggio, BSN, RN
Amy Smith, DNP, APRN, AGACNP-BC, FNP-BC
The afternoon panel brought together an EMT, an ED nurse, an ED tech, and an advanced care practitioner together to work through a nightmare case: a 36-week pregnant woman presenting at 2 a.m. with respiratory distress who deteriorated to cardiac arrest within twenty minutes of arrival. The case was a masterclass in team dynamics as much as clinical medicine. “Her vitals may not look alarming on paper, but this patient looks bad. We have to communicate that, not just the numbers.”
Practical Pearls:
EMS providers should communicate clinical gestalt when calling ahead — "this patient looks sick" is as important as the vital signs, and sometimes more so
Think about resuscitative hysterotomy the moment a late-pregnancy patient looks peri-arrest — preparation should begin before she arrests, not after
Run simulation drills for resuscitative hysterotomy at regular intervals — it is too time-critical and too infrequent to learn under pressure for the first time
Key Conference Takeaways
Women remain underdiagnosed, undertreated, and underrepresented across cardiovascular care.
Pregnancy and reproductive history are cardiovascular history and should be part of routine emergency assessment.
A normal angiogram does not exclude significant cardiac disease in women.
Social determinants, structural inequities, and communication barriers directly influence clinical outcomes.
Tracking outcomes by sex is essential; disparities cannot be fixed if they are not measured.
Listening to patients—and believing them—remains one of the most powerful clinical interventions available.