Despite warnings and their own daughters’ careers as cardiologists, when Ann Walsh and Ellen Joynt had stroke and heart attack symptoms, neither woman called 911.

“We were absolutely floored that this happened to our own mothers,” said Dr. Mary Norine Walsh, medical director of the Heart Failure and Cardiac Transplantation Programs at St. Vincent Indianapolis Hospital in Indiana.

“I was shocked she had a heart attack. And I’m a cardiologist. I know that women have heart attacks,” said Dr. Karen Joynt, cardiologist at Brigham and Women’s Hospital in Massachusetts.

Their mothers’ decisions to not call 911 led the doctors to write about the experience in an article published this week in the annual women’s issue of Circulation: Cardiovascular Quality and Outcomes.

People fail to believe a heart attack or stroke is actually happening to them and worry they’ll be embarrassed for making a false alarm. Or they suffer atypical symptoms and don’t recognize that it is an emergency.

Dr Joynt and Mom

Dr. Karen Joynt with mother Ellen Joynt

Ellen Joynt, 74, a retired physical therapist, thought she was having severe indigestion. She went to bed, but woke with severe pain radiating down her arms and up her jaw — textbook heart attack symptoms, said her daughter.

But instead of calling 911, her husband drove her to a nearby hospital. They were on a road trip from their home in Ann Arbor, Michigan, staying overnight in a small Nebraska town.

Fortunately, she was able to get immediate, high-quality care because the town had a 24-hour catheterization lab staffed by a cardiologist.

Dr Walsh and Mom flipped

Dr. Mary Norine Walsh with mother Ann Walsh

Ann Walsh, 80, of Minneapolis, Minnesota, called a nurse helpline after feeling numbness in her face and tongue and weakness in her left hand, according to her daughter. The nurse advised her to hang up immediately and call 911. Instead, she too, called a family member for a ride to the hospital.

Tests confirmed that Walsh, a retired insurance agent, hadn’t had a stroke, but her reluctance to call 911 alarmed her daughter.

Both Dr. Walsh and Dr. Joynt said their mothers knew the signs of stroke and heart attack, but neither took the next critical action step — calling 911.

Dr. Walsh suspects her mother wanted to avoid the embarrassment of an ambulance arriving at her home, where she had just moved two weeks before.  Instead of embarrassment if it turns out to be a false alarm, people who don’t have a heart attack or stroke should celebrate, she said.

“We don’t mind if people come in with chest pain and they aren’t having a heart attack,” agreed Dr. Joynt. “That’s what we’re here for.”

Women are more likely to delay seeking immediate care for cardiovascular disease than men, according to the article.  One study showed women were 3 percent more likely to delay for more than 12 hours.  However, men are less likely than women to take action for stroke.

One reason women delay care might be that they are less likely to believe that their symptoms mean they are having a cardiac event.  However, the historical lack of understanding among women that heart disease is their top health risk is changing, with awareness of heart disease nearly doubling from 30 percent in 1997 to 56 percent in 2012. There is slower improvement in awareness among black and Hispanic women than whites.

Joynt said her mom’s experiences made her examine her own biases.

“I would not have been nearly as surprised if I had been told my dad had a heart attack,” she said.  “I realized I need to open my own eyes to this issue.”

Delays in care, however, are both a men’s and women’s issue: the authors found that both men and women both delay calling 911 and both genders may experience atypical heart attack symptoms, such as nausea, shortness of breath and back pain.

“I’ve seen plenty of men with atypical symptoms and women with classic symptoms,” said Dr. Joynt.

She said it’s important to educate both men and women to recognize the signs of heart attack and stroke in others, so they can support their loved ones.  “I can’t tell you how many men come to the emergency department saying, ‘My wife, girlfriend or boyfriend made me come.’”

Healthcare establishments could help by removing barriers to seeking emergency care, Dr. Joynt said.

“It’s not fun to go to the emergency department in the middle of the night,” she said. “They’re not terribly nice places to be – we could make that better as a health care system.”

Dr. Walsh said despite not calling 911 for her stroke symptoms, the experience did have an impact.  Her mother recently called 911 after a bout of severe dizziness, diagnosed as extremely high blood pressure.

“If you have symptoms, call 911, that’s what it’s for,” Walsh said.