What are the Symptoms of Heart Attack in Women?

by Lisa Nelson, RD, LN Health Professional

Lisa Nelson RD #2:
For women the signs of a heart attack are more subtle. What should women watch for?
If everyone responded to every arm/jaw/chest/indigestion/feeling "not quite right" symptom, they'd never leave the ER

Dr. Shelby-Lane: The female heart often is misdiagnosed.

True or false: Every year, more women die of heart disease than men.

The answer is true, but if you didn't know it, you're not the only one. In a survey of 500 physicians led by preventative cardiologist Lori Mosca, M.D, Ph.D., less than 20 percent knew the answer.

When it comes to women and heart disease, ignorance can be deadly. The misconception that heart disease is a "man's disease" is the main reason women are misdiagnosed, or receive delayed treatment, when experiencing symptoms of heart disease and even a heart attack.

Consider these findings:

In a recent study at Weill Medical College of Cornell University/New York-Presbyterian Hospital, 230 physicians were given hypothetical cases of men and women with identical symptoms of heart disease. Half of the case studies included reports that the patient recently had a stressful experience or felt anxious. When this detail was included, doctors diagnosed heart disease in 56 percent of men compared with just 18 percent of women.

They referred men to cardiologists twice as often as women, and prescribed cardiac medications to almost half of the men, versus a paltry 13 percent of the women. Researchers concluded that in the presence of stress or anxiety, symptoms such as chest pain and shortness of breath were more likely to be attributed to anxiety in women but seen as potential signs of heart disease in men.

Another study at Tufts Medical Center in Boston found that among people who called 911 complaining of cardiac symptoms, women were 52 percent more likely than men to experience delays during emergency medical service care, a potentially critical difference because treatments for a heart attack are typically most effective when given within 1 to 2 hours of the start of the attack.

"We often hear women patients say that their complaints were dismissed or that they were 'blown off' by their doctors when they presented with heart disease symptoms," says Lori Mosca, M.D., Ph.D., director of preventive cardiology at New York-Presbyterian Hospital and professor of medicine at Columbia University Medical Center. "Studies show that there is a gender bias out there that women need to be aware of. Our own research has shown that physicians are likely to label a woman at lower risk for heart disease than a man who has the exact same calculated level of heart disease risk."

So how can you protect yourself? Dr. Mosca offers these suggestions:

Know your risks for heart disease, such as your waist size, smoking and exercise habits, blood pressure, and cholesterol levels. If you smoke, quit. Talk to your doctor about diet and exercise changes you can make to lower your risks, and, if appropriate, medications that might help you. Try this quick test at home: Wrap a tape measure around your waist right at the level of your belly button (don't suck in your stomach). If your waistline measures 35 inches or more, you are more likely to have high cholesterol, high blood pressure, pre-diabetes and an increased risk of dying of heart disease than a woman with a normal waist size.

Knowing your family's history of heart disease is important because if you have a close relative with heart disease or diabetes, you are at higher risk for these conditions, too.

Even if you don't have symptoms of heart disease, having a strong family history - particularly if a parent died at a young age of a heart attack - may be enough reason to be checked early to catch problems that may not yet be causing symptoms. In 40 percent of people that develop heart disease, sudden death is the first symptom.

Learn the unique symptoms of heart disease in women.

Chest pain is the most common symptom of heart problems in both men and women, but women are much more likely to also experience subtle symptoms such as headaches, nausea and upset stomach, jaw or neck pain, shortness of breath and generalized fatigue.

Get help immediately. "Research shows that women tend to call for help later than men do, possibly because they don't recognize these atypical symptoms as signaling heart troubles, or possibly because their tolerance for pain is greater," says Dr. Mosca. If you have symptoms and think you might be having a heart attack or stroke, don't delay; call 911.

Have a checkup annually. Report any suspicious symptoms and don't let your doctor dismiss your concerns. If you have two or more risk factors and you are over the age of 50, a stress test can give more clues to your heart health. If the stress test shows signs of potential heart problems, further tests can be ordered.

Get a second opinion. If you feel your doctor is not taking your concerns seriously don't hesitate to find a new doctor.

Lisa Nelson RD: Okay, this was a fantastic answer and I appreciate the detail, but I want to clarify.
Are you saying if a woman experiences chest pain and an additional symptom, such as headache, nausea, or shortness of breath they should contact their MD immediately; but if it's just shortness of breath by itself or just neck pain, not such a concern, monitor and watch for any changes.
Is that correct?

Dr. Shelby-Lane:
If a woman experiences chest pain along with symptoms such as on-going headaches, nausea, fatigue, and shortness of breath, they should contact their doctor immediately and/or go to the emergency room, especially if these symptoms are of sudden onset.
Symptoms such as shortness of breath, fatigue and neck pain may also be subtle indicators of heart disease and most women may dismiss these symptoms and never mention them to their doctor, thereby, missing the opportunity to diagnose an underlying heart problem.

To learn more about Dr. Cynthia Shelby-Lane, you can check out the services she offers at www.elanantiaging.meta-ehealth.com.

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Lisa Nelson, RD, LN
Meet Our Writer
Lisa Nelson, RD, LN

Lisa Nelson RD, a registered dietitian since 1999, provides step-by-step guidance to lower cholesterol and lower blood pressure, so you can live life and enjoy your family for years to come. Lisa's passion for health comes from her own family history of heart disease, so she doesn't dispense trendy treatments; Lisa practices what she teaches in her own daily life. Because her own health is the foundation of her expertise, you can trust that Lisa will make it truly possible for you to see dramatic changes in your health, without unrealistic fads or impossibly difficult techniques.