Women and Heart Attacks
Most of us know what it looks like when a man has a heart attack — the classic chest-clutching, pain-down-the-arm episode. Until recently, we had no idea that a woman’s symptoms were any different. But thanks to ongoing research involving over 1,500 women by Jean McSweeney, RN, PhD, of the University of Arkansas for Medical Sciences, we’re getting a clearer picture. Here she reveals the signs that should have you dialing 911.
Q. Which heart attack symptoms are women more likely to have?
A. The number-one symptom is shortness of breath. It comes on without any obvious cause — you just can’t take a deep breath. Sudden anxiety is another common symptom. Our study subjects described becoming anxious as a result of the shortness of breath or simply having a feeling of doom or dread that wouldn’t let up. Women who smoked sometimes tried to light up to lessen their anxiety, only to find that cigarettes suddenly tasted horrible. They also recounted feeling weak and a sense of overwhelming exhaustion.
Q. Do women have any warning signs that a heart attack is coming?
A. In our studies we found that women may have months of warning. Often the same general symptoms occur both as early warning signs and as manifestations of a heart attack. As warning signs, they are intermittent and are not as severe. The most common symptom was unusual fatigue, reported by more than 70 percent of our study subjects. This is not fatigue because you didn’t sleep well the night before or because you had a long day. Rather, this is the sort that keeps you from performing normal activities. Maybe you can still drag yourself to work, but you can’t climb the stairs at night. Some women described fatigue so intense they had to stop and rest between making the left and right sides of the bed.
More than 40 percent of women remembered becoming short of breath, which often comes and goes, and it gets better with rest. In the months before a heart attack, it progressively worsens. Being short of breath during regular activities is never normal.
Women often described severe and increasingly frequent indigestion that they couldn’t connect with eating any particular food and that antacids couldn’t always relieve. Tell your doctor about these symptoms; the nerve endings of the heart and the stomach are very close together. Many also had fleeting periods of anxiety as a warning sign; these got better in 30 minutes or sooner. Although they didn’t feel anxious in general, women were often prescribed antianxiety medication, but this simply masks the true culprit.
Finally, almost half the subjects reported sleep disturbances. In upcoming studies, we’ll look more closely to see whether these follow a specific pattern. Over three-quarters of our subjects recalled having at least one of these warning symptoms for more than a month, either daily or several times a week, before their heart attacks. Unfortunately, many didn’t realize what was going on or were not diagnosed properly, so they went on to have attacks, thus damaging their hearts.
Q. Why don’t women complain of chest pain?
A. When asked about chest discomfort or pain during their heart attack, only 57 percent said that they had any. They reported generalized discomfort in the chest, breast, back, shoulders, neck, or throat. And instead of the crushing pain that nurses and doctors hear about from men, women tend to label theirs heaviness, pressure, burning, and/or tightness. Some of this may be because women use different adjectives than men, but it may also be because of a difference in the nature of an attack; we simply don’t know yet.
Q. Is lack of reported chest pain why women’s treatment is often delayed?
A. That’s one reason. Patients who complain of chest pain certainly are diagnosed much more quickly. But even women with classic crushing chest-pain symptoms don’t always act on them. We just saw one woman in her late 40s who experienced chest pain for two days prior to a massive heart attack. Her family encouraged her to stay off her feet and rest, because they thought she was too young to be having an attack.