Morgan Granzow - MSc Dissertation

Inequalities in Cardiac Care: How Medical Illustration Can Bridge Gender Gaps in Healthcare

Despite making up half of the affected population, women endure extensive inequalities in cardiovascular care. Historically male-centered research has created systematic bias that deeply affects women’s access to healthcare. Biased perspectives and misconceptions lead society to prioritize modesty over life-saving care. Visuals surrounding cardiovascular care tend to feature fit, male bodies, creating a limitation in representation and gaps in education. Currently, there are no known visuals that depict ECG placement in relation to breasts and there are minimal visuals in related cardiac care material such as performing CPR, defibrillator placement, and women’s heart attack symptoms. Having little to no visuals reinforces systematic bias in care by limiting the resources on women’s health. This directly correlates to women being much less likely to receive CPR, experience more misdiagnoses and delays in care, and less likely to be taken seriously, all contributing to a much higher mortality rate compared to that of men. The goal of this project was to create a series of cardiovascular care visuals centered on women to draw attention to the healthcare inequality women face and to be used as educational resources to provide equal access to lifesaving measures. The illustrations that were created during this project targeted two groups, the general public and healthcare professionals/students. With those two groups in mind, the project was separated into two categories, public intervention and medical education, with some overlap and supplemental illustrations. The public intervention illustrations included illustrations on CPR, defibrillators, and symptoms, while the medical education illustrations focused on ECG lead placement and anatomy. As a medical illustrator, one has the power to evoke change in communities by representing various individuals. By visualizing complex or misunderstood scientific information, viewers can gain an understanding of the concepts to make informed decisions about their healthcare. These illustrations can help bridge the gender gap in cardiovascular healthcare and promote more attention to the matter.

"Healthy Heart" depicts the anterior view of the heart and is left unlabeled to serve a variety of purposes in medical student education. This illustration, alongside many others, are displayed at Ninewells Hospital Cardiac Cath Lab.

"Cardiopulmonary Resuscitation (CPR)" was designed to be aimed at the general public and encourage people to learn CPR and have more comfort with interacting with women’s bodies during life-saving care. As the research shows, many people are uncomfortable with performing CPR on women due to modesty and fear of touching women’s bodies. By displaying a woman receiving CPR, hopefully viewers will have more comfort in performing life-saving care.

"Symptoms of Heart Attacks in Women" displays symptoms that mainly affect women and have been labeled as atypical, despite affecting half of the population. The intention of this illustration is to educate people on the signs of a heart attack and encourage individuals to seek medical care if they are experiencing these symptoms.

"Anterior View of the Heart" was created for individuals to learn about the heart anatomy. This diagram labels the anterior anatomy of the heart for medical students learning about the heart or patients to follow in conversations with their doctors.

"ECG Leads in Relation to Anatomical Landmarks" showcases the landmarks medical professionals use when placing the chest leads. While all body types vary, the underlying anatomy is the same, thus creating an “anatomical” guide for where the leads go. This illustration visualizes where those leads are aiming for when placed on the skin.

"ECG Leads in Relation to the Heart" visualizes how to read the ECG results. Each precordial lead corresponds to different areas of the heart, allowing medical professionals to locate which area of the heart is not working properly.

"ECG Precordial Lead Placement" consists of three illustrations of different body types and skin tones. This illustration is incredibly important because incorrect lead placement can result in misinterpretation of the ECG and electrical interference. In order to avoid this, medical professionals are asked to lift the breast, or have patients lift their breast, and place the leads correctly.

This additional illustration goes alongside "ECG Precordial Lead Placement" to showcase the limb leads, as well.

"Myocardial Infarction (Heart Attack)" compares a healthy heart to one affected by a heart attack. While most individuals have heard of a heart attack, they might not understand what exactly is happening inside the body. This piece visualizes the anatomical differences when an artery is blocked and affects the muscle of the heart.

"Automated External Defibrillator (AED)" depicts the proper placement of a defibrillator, targeted at the general public. AEDs are often in most public settings and come with basic instructions, meaning that anyone can use one without any prior experience. This illustration is aimed at providing a visual to follow, while also providing reassurance that removing all clothing and cutting off a woman’s bra is completely necessary.