If you were asked to describe a “typical” heart attack, you might describe an older man with his hand on his chest in severe pain. This image, seen so frequently on television and in movies, has become ingrained in the minds of many Americans who often use this idea to decide if their own symptoms indicate a heart attack. The use of this heart attack stereotype may explain the findings of a new study published this week that found that younger women who have a heart attack often discount their symptoms and wait for longer than they should to get help.

Why did the researchers look at young women?

Most heart attacks occur in older adults over the age of 55. As a result, most efforts to raise awareness about heart disease and heart attack risk have been aimed at older segments of the population since those people are most likely to benefit. But the number of heart attacks that occur in younger people is still significant. Every year about 15,000 women under the age of 55 die from heart disease.

On top of that high number, women in this age bracket tend to do worse than men when they have a heart attack. A young woman who has a heart attack is about 50% more likely to die from that heart attack than a young man. While that effect is dramatic, the reason for the increased death risk is still unknown. Studies in older women indicated they might be waiting longer to seek help, but the data had never been gathered in younger women.

How did they figure out what was going on?

The researchers interviewed 30 young women who had heart attacks. They talked to the women about their experience, what their symptoms were, how they responded to them and why they acted the way they did when they started having the symptoms. They wanted to understand their experience and why they responded the way they did.

What did they find in their interviews?

The researchers found the women’s experiences fell into five categories.

• Symptoms varied from the typical symptoms dramatically. Pain was felt in the chest, arms, hands, back, jaw, shoulders, neck, legs and throat. Women also experienced trouble breathing, fatigue, indigestion symptoms, headaches, nausea, anxiety, sweating, feeling hot, feeling dizzy, feeling weak, and palpitations. Some women found these symptoms came on suddenly, while others had a more subtle sense that something was just generally wrong. These women often said their symptoms came and went over days, weeks or months before having their heart attack.
• Women didn’t know they were at risk. Most of the women admitted that they didn’t know they were at risk for a heart attack before having one, even if an examination of their health and family history by a physician later indicated that they were at high risk. Many women also said they never put the pieces together. Since their symptoms didn’t fit the typical case, they wrote them off as symptoms of other problems like stress, age or chronic illness.
• Even when they knew something was wrong, they hesitated. Many women noted the many other considerations they took into account when deciding to seek help. They worried about raising a false alarm and were concerned about who would take care of their family and other responsibilities if they left to get help. Most waited until their symptoms were so bad that they had no choice but to go to the hospital.
• Healthcare workers didn’t recognize their symptoms. Because many women had less common symptoms, it took longer for health care providers to figure out they were having a heart attack when they did seek care. Even when their symptoms were typical, it took longer to reach a diagnosis because their age and gender didn’t fit the stereotype.
• These women didn’t get checked for heart disease risk. Most of the women admitted they rarely went to the doctor for regular checkups, often because other responsibilities got in the way. When they did, they said heart disease risk was almost never discussed.

Why is this study important to me?

The goal of this study is not to blame young women for not acting, but to encourage them to do so when they know something is wrong even if they aren’t sure what the problem is. Don’t be fooled by the Hollywood heart attack. Your symptoms may be very different from those you see on TV. This study shows that going to the doctor and having a conversation about your heart disease risk may save your life.

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