Heart attack warning signs are often different in women

It started with a heavy feeling in her chest. Then ‘Mary’ was experiencing night sweats like she had when she was going through menopause. She felt nausea but didn’t throw up. She also had difficulty breathing, similar to what she imagines a panic attack might feel like.

“I had several days of the heavy feeling in my chest, so I would just lie down and try to rest a bit, thinking I was overworking myself,” said Mary, who asked that her real name not be used.

At 66 years of age, it didn’t really occur to the Dennis resident that she might be having a heart attack, but that is exactly what she was experiencing. She finally decided to go to Cape Cod Hospital, because she couldn’t relieve the nausea and, even though she couldn’t put her finger on any one thing, she just felt like something wasn’t right.

“The night before, I just couldn’t fall asleep, like my body was trying to tell me to do something,” she said. “So, listening to your body really works.”

Once she arrived at the hospital, doctors placed two stents in the arteries going to her heart and she was prescribed new medications. She is now on the mend and grateful she didn’t ignore her symptoms.

As scary as Mary’s experience was, it is not an uncommon one. Numerous studies show that women are more likely than men to dismiss the warning signs of a heart attack. Researchers are now focused on why that is.

Studies show that a large part of the blame can be attributed to the fact that women have different and often more subtle symptoms than men.

“Often, women don’t think they have heart disease so when they have symptoms it just doesn’t come to their mind, because classically the public thinks of heart disease as being in men,” said Cape Cod Hospital Cardiology Hospitalist Jennifer Ladner, MD. “Women are less likely to have the classic sort of chest pain, and they also discount symptoms as fatigue and that throws them off. It throws doctors off too.”

She noted a study of 218 men and women that showed that 62 percent of the women in the study did not have any chest pain or discomfort while the same was true for only 36 percent of the men. Because they didn’t have chest pain, the women in the study didn’t realize they were having a heart attack, which caused them to delay seeking treatment for a longer period of time than men.

Women can have chest pain with a heart attack, but they are more likely to have other non-chest pain symptoms, including:

• Shortness of breath,
• Unexplained fatigue,
• Feeling lethargic,
• Jaw or shoulder pain,
• Breaking into a cold sweat,
• Nausea,
• Pressure on the chest that may come and go.

Anyone experiencing any of these symptoms should get to the hospital right away.

There are also more subtle signs that a woman has heart disease, even if she isn’t currently having a heart attack. A woman who normally walks two miles a day but finds she has to stop halfway might be tempted to think her change in exercise tolerance is just normal aging. Instead, it is a sign of a possible developing heart problem.

“Exercise tolerance really shouldn’t change if you exercise regularly,” she said. “If that happens, you should definitely talk to your doctor about it because that’s not normal. Your tolerance does change over a period of 20 years, but not over a period of months. If that happens, it should be a red flag that something is up.”

Part of the reason that women are not diagnosed with heart disease as early as men is they tend to downplay their symptoms, said Dr. Ladner. They chalk them up to fatigue or anxiety, like Mary did. Because of that, they not only wait longer to seek medical care, but they are also more likely to downplay symptoms when they do talk to a doctor. That means they may not get a stress test or other diagnostic monitoring as early as men do.

“Because women have fewer classic symptoms of heart disease, their heart disease tends to be discovered later in the course,” Dr. Ladner said. “So, there is a risk of complication from their heart disease because it is just discovered later.”

The other dynamic at play is that heart attacks and deaths have been rising in women between the ages of 35 and 54, due to obesity and the resulting increase in metabolic disorders like hypertension and diabetes. That cohort of patients is even less likely to suspect they are having a heart attack because they haven’t been taught it’s even possible.

Both the American Heart Association and the Women’s Heart Alliance are trying to raise awareness about heart disease in women. The Women’s Heart Alliance released a video featuring the music of Lady Gaga to educate women about the symptoms.

Actress Elizabeth Banks made a video for the American Heart Association’s “Go Red for Women” campaign called “Just a Little Heart Attack.” In the video, Banks plays a busy multitasking mother who ignores symptoms like an aching jaw, pain in her arm and sudden sweatiness. The video is especially pertinent to younger women who can have even more subtle symptoms, according to Dr. Ladner.

Even though pre-menopausal women have some protection against heart disease simply by the fact of their gender, the obesity epidemic is tipping more of them into a riskier category, she said. Obesity leads to hypertension and diabetes, which are both known risk factors for heart attacks. Other risk factors include smoking, a family history of heart disease, high cholesterol and a sedentary lifestyle, she said.

One reason why chest pain has traditionally been associated with heart attacks is because all of the early studies were mostly done on men, Dr. Ladner noted. She pointed out that early studies of the symptoms of heart disease involved cohorts that were 75 to 80 percent men.

“So of course, the signs and symptoms were going to be skewed toward men because there were a lot more of them.”