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.
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."