Studies are in progress to figure out whether women need more sophisticated tests that can pinpoint problems, Eagle said. These tests may include 64-slice computerized tomography (CT) scans and MRIs. For now, there's no proof that such costly technologies pay off, he said.

Eagle and Riba's study appeared last month in the Archives of Internal Medicine, a leading journal.

It is just the latest in a growing pile of evidence that men's symptoms are treated more aggressively than women when it comes to heart care.

The study looked at more than 4,000 heart attack survivors at 33 Michigan hospitals between 1999 and 2002. The hospitals were not named in the study. The women were Medicare recipients about 75 years old.

"We're troubled by the gender differences we found, though we remain encouraged by the overall effect of post-heart-attack quality improvement efforts," Eagle said.

"The gaps and disparities are narrowing because of education and high-profile programs," Riba said. "But we haven't been able to get the message to everyone yet, and clear-cut differences remain.

"It's challenging, but we're beginning to make a difference."

Treatment starts first with getting to the hospital promptly, as Crossman learned. Her excuse: "I didn't want to be a pain. I've always been like that," she said, despite a history of heart problems. She has undergone procedures to place seven stents to prop open her arteries over the years.

She has diabetes, lupus, arthritis and chronic obstructive pulmonary disorder, a lung disease from years of smoking. She resumed the habit three weeks ago, after stopping for a year.

Crossman's mother died of a heart attack at age 56. She, too, didn't bother others with medical issues.

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WHAT WOMEN SHOULD KNOW ABOUT HEARTS

QUESTION: What is heart disease?

ANSWER: Heart or cardiovascular disease is a cluster of conditions, including strokes, that affect the heart and blood vessels that supply it.

Q: What causes it in women?

A: High blood pressure, diabetes and high cholesterol are typical causes of heart disease. Other factors that increase a woman's risk include smoking, obesity, oral contraceptive use after age 35 and an endocrine disorder known as polycystic ovary syndrome.

Q: How much does a family history contribute to heart disease?

A: A heart attack in a sibling raises a person's risk three to four times; one in a mother or father, one and a half times. Of greatest concern is if a father or brother had heart disease before age 55, or a mother or sister before age 65.

Q: Is heart disease an older person's problem?

A: Heart disease risk increases with age, but it can occur any time. Typically, though, it occurs 10 years later in women than men, after menopause.

Q: Why?

A: Women's natural production of estrogen prior to menopause protects them against heart disease. As the hormone wanes after menopause, they lose that natural protection. It is no longer thought that supplemental hormone provides women the same benefits against heart disease.

Q: Are women's hearts different than men?

A: Yes. Their heart muscle, as well as the vessels supplying it, tends to be smaller. As a result, blockages in smaller arteries don't always show up on tests.

Q: How do women avoid heart problems?

A: The best way to reduce risk is through lifestyle changes, particularly, weight loss if needed; 30 minutes of daily exercise; and a low-fat diet. Extra weight causes the heart to work harder, raises blood pressure, increases your bad cholesterol and triglycerides and decreases your good cholesterol.

Avoid processed foods, sweets and carbohydrates. And get regular checkups and blood tests. Ask for the breakdown of components of cholesterol, not just the total number.

Q: What causes a heart attack?

A: Usually, the arteries that supply the heart or brain with blood slowly develop deposits of cells, fat and cholesterol, or plaque. This buildup can narrow blood vessels and cause them to burst, causing a heart attack or stroke.

Q: What should a woman do if she has symptoms such as chest pains, shortness of breath or abdominal discomfort?

A: She should call 911 or go to the nearest emergency department, preferably one large enough to perform heart surgery.

Q: What care should a woman or her family be sure she receives at a hospital?

A: If admitted, she should get individual counseling about smoking cessation, nutrition, daily exercise of at least one half-hour and follow-up care for the next year at regular intervals with primary care doctors. And with her doctor, she should go over what medicines she will need to take.

Q: What medicines typically are prescribed?