Daniel Steenstra

#FBPE Academic entrepreneur working on sustainable equitable healthcare using AI. Sailing in Med to maintain perspective. Escaped from Brexit Little England.

[Daniel Steenstra @danielsteenstra]

Implement Legislation for Individual Legal Duty of Candour for all Public Officials - Sign the Petition! https://t.co/87XGkiffqh via @UKChange

[Daniel Steenstra @danielsteenstra]

@xashtreex @PeterTFortune Firing warning shots at a civilian vessel during peacetime is considered a highly escalatory law enforcement action. In the absence of an armed conflict, a warship's actions are governed by international maritime law—chiefly the United Nations Convention on the Law of the Sea

[Daniel Steenstra @danielsteenstra]

@PeterTFortune As a fellow yachtsman how is this not an act of war?

[Afshine Emrani MD FACC @afshineemrani]

I'm a cardiologist. A 42-year-old mother of two came to my office complaining of jaw pain and crushing fatigue. She ran half-marathons. Her EKG was normal. Another doctor had sent her home with anxiety medication.
When I got her into the cath lab, I found severe microvascular disease — plaque choking the tiniest vessels of her heart, the ones standard angiograms routinely miss.
Her heart had been starving in silence while everyone told her she was stressed.
She is alive today. Too many women like her are not.
Heart disease kills more women than every cancer combined. And medicine is still diagnosing it through a male lens.
84% of cardiologists report having patients in the past year whose heart disease was misdiagnosed by another physician. Women with a STEMI heart attack have a 59% greater chance of being misdiagnosed compared to men. Women with an NSTEMI — 41% greater chance.
The reason is structural. For decades, we screened, tested, and treated women using a template built for men.
Men's heart attacks announce themselves — the crushing chest pain, the clutched fist, the Hollywood collapse. Women's hearts whisper. Crushing fatigue that feels like wearing a lead vest. Jaw pain written off as TMJ. Nausea blamed on a stomach bug. An ache between the shoulder blades blamed on a long week. Shortness of breath blamed on being out of shape.
For years, medicine called these "atypical" symptoms. They are not atypical. They are female-typical. Half of humanity is not a variant.
And the biology runs deeper than symptoms.
Women have smaller hearts and narrower coronary arteries. Plaque doesn't only clog the big highway vessels — it hides in the microvasculature, the tiny branches feeding the heart muscle itself. A woman can have a heart attack with a completely "clean" standard angiogram.
SCAD — spontaneous coronary artery dissection — occurs 90% of the time in women. Often young, fit women with zero traditional risk factors. It's the leading cause of heart attack in women under 50, accounting for roughly one quarter of all cases in that age group. Most doctors have never diagnosed one.
And some of the most dangerous cardiac risk factors are hidden in women's medical histories where no one thinks to look:
Preeclampsia or gestational hypertension doubles to quadruples lifetime heart disease and stroke risk. Pregnancy is the body's first cardiac stress test — and these complications are early warning sirens, not closed chapters.
Autoimmune disease — lupus, rheumatoid arthritis, psoriasis — far more common in women, turbocharges inflammation and plaque formation at any age.
Cardiovascular disease in women aged 20-44 is projected to surge nearly 50% by 2050.
The youngest patients in my practice keep getting younger.
What every woman should ask her doctor — and what every doctor should be asking:
"Given my pregnancy history, autoimmune status, and family history — what is my full cardiovascular risk?" If they don't ask about preeclampsia or gestational diabetes, volunteer it.
"Should I have an Lp(a) test and a coronary calcium score?" Standard cholesterol panels miss too much. Lp(a) is genetic, one-time, and most women have never been tested.
"My tests came back normal but my symptoms haven't stopped — what's next?" Normal stress tests and angiograms can miss microvascular disease, spasm, and SCAD. Persistent symptoms warrant coronary CT angiography or cardiac MRI.
And if something feels wrong — say these exact words to your doctor: "I am concerned this could be my heart."
That single sentence changes the workup. Do not soften it. Do not apologize for it.
80% of heart disease is preventable. But the playbook has to be built for female biology.
Two decades ago, I wrote one of the first books warning that heart disease was the number one killer of women and that medicine was diagnosing it through a male lens. It was recognized by First Lady Laura Bush at the White House during the early years of the national conversation about women's heart health.
I'm haunted by how much of that book I could republish today unchanged.
The science has advanced. The awareness has grown. But the gap between what we know and what happens in the exam room is still costing women their lives.
Share this with every woman you love — and every doctor who treats them. READ MORE: https://t.co/4LRugiY8q2

[Daniel Steenstra @danielsteenstra]

8 years later we now know what happened next

[Daniel Steenstra @danielsteenstra]

The Brexit bus on the cliff ...

[Daniel Steenstra @danielsteenstra]

@ayeshavisk41781 8

[Daniel Steenstra @danielsteenstra]

@Arden_2210 37

[Daniel Steenstra @danielsteenstra]

@odidonederland There’s Nothing you can do to make up for this.

[Daniel Steenstra @danielsteenstra]

@odidonederland so you kicked my wife and mine iPhone of the network after returning from 2 month Australia whilst we continued to pay.

[Daniel Steenstra @danielsteenstra]

@odidonederland Odido must have removed our phones from network whilst taking our money. Unbelievable bad and inexcusable. Will definitely change providers

[Daniel Steenstra @danielsteenstra]

@odidonederland Travel from Schiphol by train to Blijham challenging without phone or data service.

[Daniel Steenstra @danielsteenstra]

@odidonederland Already tried chat and email. Neither worked for us. After 2 months abroad (whilst still paying) we cannot use phone or data. Both identical iphonr14

[Daniel Steenstra @danielsteenstra]

Complex System Immunity Theory: From Healthcare Transformation Failure to Universal Principle @SSRN https://t.co/Cb4HGFaTmZ

[Daniel Steenstra @danielsteenstra]

@prioritypasscom Disappointing that Rex Lounge at SYD T2 couldn’t be bothered to open on time today. No apology. No explanation. Uselessly

[Daniel Steenstra @danielsteenstra]

The irony: @SingaporeAir has world-class cabin crew but UX designers who can't grasp Design 101. Don't offer auto check-in to passengers requiring in-person verification. EXPLAIN why it failed instead of deleting Calendar entries. Basic design. Inexcusable for premium airline

[Daniel Steenstra @danielsteenstra]

@SingaporeAir Auto check-in confirmed Sep. Failed Dec 7—no explanation. Manual check-in failed. System deleted confirmed flights from calendar. Emailed complaint. Reply: "we understand your frustration, travel with another airline." 15+ years flying SIA to Singapore. Never again

[Daniel Steenstra @danielsteenstra]

@BladeoftheS If only a lying sack of 💩, he’s a killing sack of 💩

[Daniel Steenstra @danielsteenstra]

@EHijacked A clown? If only. He’s a killer and should be locked up. The only difference between Boris and Hitler are the numbers.

[MattGolding Cartoons @GoldingCartoons]

The News in Grief. @theage

[Sayeeda Warsi @SayeedaWarsi]

I’m not prepared to accept that a country my grandfathers fought for , a country my father helped build , a country I served in Cabinet, a country my child serves in our armed forces may no longer be a country my future generations will call home
@GMB
My siren call in my new book Muslims Don’t Matter
https://t.co/qMEr6mWPVR