Unfortunately, women are extremely good at downplaying the significance of symptoms and talking themselves out of seeking help. Or they call family and friends, and are falsely reassured that they couldn’t possibly be having a heart attack. Women are often afraid of wasting money or being embarrassed at going to the emergency room and finding out nothing’s wrong. My strong advice: Call 911 if you suspect you’re having a heart attack. Don’t die at home waiting to see if things will get better.
Q. Some of these symptoms seem pretty vague. Could that be part of the problem?
A. Absolutely. We wondered whether all women have these experiences, or if there is really something different about women headed for heart attacks. So we asked 100 healthy women about early warning symptoms and found that the women who went on to have heart attacks were much more likely to report that they experienced many more of these signs more frequently than healthy women. Surprisingly, the only thing that was not different was chest discomfort — healthy women had almost as much chest discomfort and pain as women who went on to have heart attacks. That means that chest pain may not be the most helpful symptom in women. If 40 percent of women don’t have chest pain during a heart attack, and about 50 percent of healthy women do report having recent chest discomfort, that tells us we need to be looking more closely at other symptoms as we assess women for heart disease.
In our next study, funded by the National Institute of Nursing Research, we’re tracking 1,500 women for two years after they have an initial cardiovascular evaluation. We’re going to ask about early warning symptoms every three months, charting how those symptoms change in frequency or severity over the two-year study period, whether medication affects symptoms, and which symptoms best predict which women will actually go on to have heart attacks or require heart procedures such as having a stent placed or undergoing a bypass graft. The ultimate goal of the study is to come up with a list of the symptoms most predictive of possible heart disease.
Q. What should you do if you experience the warning signs?
A. Don’t be scared by just one thing — the women who had heart attacks had an average of six different early warning symptoms. But if you’re concerned, schedule a thorough checkup. Describe any symptoms that are new, troubling, or affecting you on a daily basis. Tell your doctor that the reason you are there is because the symptoms have you concerned about your heart, and remind her about other heart disease risk factors you have.
To make sure a doctor doesn’t downplay your symptoms, describe in practical terms how they are affecting your ability to perform normal daily activities. Don’t just say, "I’m tired"; say, "I can’t walk to the mailbox." Describe what you were able to do a month or so ago and how it has changed. Don’t say, "I get indigestion"; say, "I get indigestion even with even nonspicy foods, and 15 Tums don’t faze it." Your doctor should be able to evaluate the symptoms in light of your heart disease risk factors or refer you to a cardiologist.
Q. If women and their doctors take women’s heart attack symptoms more seriously, will fewer women die?
A. Frighteningly, women who suspected they were experiencing early warning signs in the months before their attacks had difficulty receiving a correct diagnosis — and heart-saving help — when they reported their symptoms to their doctors. Our aim is to significantly delay or prevent a heart attack. That’s crucial because when women have heart attacks, they are more likely than men to die, to be disabled for life, or to have a second heart attack. Anything we can do to prevent or delay a heart attack increases a woman’s chance of a longer, higher quality life.
More on Heart Disease
Originally published in MORE magazine, September 2007 as "Heart Health Alarms."