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Fatigue. Lightheadedness. Back pain. Signs of the flu? Or being overstressed? Maybe. But in women, these could also spell heart attack. That may sound surprising, mainly because chest and arm pain are the “telltales” most often talked about. For women, however, some of the common signs of a heart attack are far less obvious than in men.
Studies show that women are less apt to act quickly when having a heart attack. Too often they take too long to seek medical attention, likely and at least in part, researchers say, because of uncertainty about what they are experiencing and whether or not it constitutes an emergency.
The signs of a heart attack can be different enough in women that even healthcare professionals don’t act as fast as they should: One study found that women were 50 percent more likely than men to experience delays in treatment for cardiac symptoms while in emergency care. The results of this can be dire.
This, of course, is startling. But if you’re a woman, learning the symptoms that you should paying closer attention to could save your life.
First, it’s important to note that classic angina—a feeling of pressure, pain and/or squeezing in the middle of your chest—is the most common sign of a heart attack for both women and men. During a heart attack, both genders also frequently experience pain or discomfort in one or both arms, shortness of breath (with or without chest discomfort), breaking out in a cold sweat and/or nausea or vomiting.
But if you’re a woman, you’re more likely than a man to feel any of these symptoms when you’re having a heart attack, too:
Because these five signs are so vague, they can be a lot easier to dismiss as, well, almost anything. It’s worth a reminder here that if you ever think you’re experiencing a heart attack you should call 911 immediately. It’s not advised that you drive yourself. Emergency Medical Services (EMS) personnel can start lifesaving treatment as soon as they arrive, and starting treatment early can be lifesaving.
WHY IT’S EASY TO MISS
Vague symptoms aren’t the only reason why a woman’s heart attack might go untreated.
First, cardiovascular problems that put a person at risk of a heart attack can be harder to detect in women, and without these red flags, female patients and their physicians might be less likely to realize a heart attack is happening when it strikes. Women’s arteries are smaller than men’s, and when plaque builds up it may be more evenly distributed, making it potentially harder to catch.
Also, women more often than men have coronary microvascular disease (MVD), also called cardiac syndrome X. Here, tiny arteries, rather than large ones, are damaged. “If a cardiologist is concerned about a patient having a heart attack, the first test for both men and women is the cardiac catheterization, in which dye is injected into the arteries to see if they’re open or closed,” says Nicola Finley, M.D.,
“However, when we do a cardiac catheterization, we’re looking at the macrovascular system.” This common test won’t pick up MVD. (If you have a cardiac catheterization that doesn’t turn up anything, your doctor can look for MVD with options such as a cardiac MRI, Dr. Finley says). MVD also occurs more often in younger women, who are typically even less apt to think “heart attack” when they notice symptoms, especially the more non-descript ones.
Plus, “some women tend to minimize the signs of a heart attack because they already have so much on their plates that they’re worried about,” Dr. Finley adds. “We put other people first, and that’s one reason why there’s often a delay in treatment.” Of course, you don’t want to call 911 just because you’re tired, but Dr. Finley has seen her share of patients who didn’t pay attention to vague symptoms that turned out to be serious heart problems. That’s why she stresses the importance of not ignoring even those general, “it’s probably nothing,” indicators.
WHAT CAN HAPPEN WHILE YOU WAIT
Heart attacks typically occur when one or more of the arteries of the heart are clogged. Remember that your heart is a muscle that needs a steady supply of oxygen. “If you don’t have oxygen-rich blood going to the heart muscle, it will start to die,” Dr. Finley explains. The longer you linger before seeking help, the more potential damage that’s being done to your heart. In the worst-case scenario, the muscle will be unable to maintain its normal rhythm and sudden cardiac death will occur.
“The flip side is that once the EMS personnel arrive on the scene, they can initiate the appropriate treatment, like administering oxygen and starting CPR early,” Dr. Finley says. “This will allow the blood to be oxygenated so there’s less damage to the heart muscle. And it allows the oxygenated blood to be circulated in your body so it can reach vital organs.”
FACTORS THAT RAISE YOUR RISK
Knowing when a heart attack is happening can be a game changer, and you might be more likely to spot the signs if you’re aware of your individual risk. The more risk factors you have for cardiac trouble, the greater the chance that what you’re experiencing is indeed a heart attack.
“A family history of heart disease puts you at an increased risk, as does smoking, overweight and obesity, being sedentary, having high cholesterol or high blood pressure,” Dr. Finley says. “Diabetes is a huge risk factor,”she adds, and women with polycystic ovary syndrome or a history of preeclampsia (high blood pressure during pregnancy) also have an elevated risk. “If you don’t have those risk factors you can still have a heart attack,” Dr. Finley adds, “but it’s important to know if you’re at an increased risk.”
Lowering your risk—by managing stress, getting lots of movement into your day, eating a heart-smart diet and implementing other key changes—will make it less likely a heart attack will be in your future.
“Because heart disease is the number-one killer of women, this is such an important topic for women to know about,” Dr. Finley says. “If you have risk factors that can modified, then lifestyle changes are a great approach to lowering your risk of having a heart attack.”
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