If you ask anyone on the street to name a common warning sign for a heart attack, most likely that person would tell you chest pain is a pretty common warning sign. And if we were considering warning signs for heart attack in men, that answer might fit. However, research has shown that heart attacks in women present differently. Heart disease is the number one killer for women both in developed and in developing countries though women are typically about a decade older than men generally are before they develop the disease. The chief of cardiac rehabilitation at New York’s Lenox Hill Hospital, Dr. Nieca Goldberg, says “that women often [are] not accurately diagnosed because they may not have the classic symptoms seen in men.” The gender differences in women’s risk factors, warning signs, and best testing and treatment options for a heart attack have been explored in research over the past 10-15 years.
Women’s Risk Factors for Heart Attack
The most preventable risk factor for heart attacks in women is smoking, particularly for women under age 50, and the risk increases with the amount of tobacco consumed as well as the use of oral contraceptives. Diabetes also increases the risk of heart attack for women up to 3 times more than men with diabetes. Hormone replacement therapy increases the risk, too, and psychological factors like depression, marital stress, and anger affect women more than men. In fact, “emotional stress is more likely to trigger an acute coronary event in women than physical exercise.” The good news is that having an optimistic mindset and family support reduces the likelihood of a coronary event.
Women’s Warning Signs of a Heart Attack
A 2003 study surveyed 515 women ranging in age from 29 to 97 who had had a heart attack during the previous 4-6 months and were discharged from 5 hospitals located in Arkansas, Ohio, and North Carolina. Nearly all the women (95 percent) reported that they had exhibited new symptoms a month before the heart attack and that these new symptoms went away after the heart attack, so researchers made the correlation between the symptoms and the heart attack. These warning signs included the following:
- Unusual fatigue (reported by 70 percent of women)
- Sleep disturbances (reported by 48 percent of women)
- Shortness of breath (reported by 42 percent of women)
- Indigestion (reported by 39 percent of women)
- Anxiety (reported by 35 percent of women)
The study showed that only 30 percent of the women actually experienced chest pain which is the primary warning sign for men. Lead author of the study Dr. Jean McSweeney said, “Lack of significant chest pain may be a major reason why women have many more unrecognized heart attacks than men or are mistakenly diagnosed and discharged from emergency departments. Many clinicians still consider chest pain as the primary symptom of a heart attack.”
Women’s Best Testing and Treatment for Heart Attack
The best modes of testing and treatments for women can differ from men. For example, half of women with heart disease present normal coronary arteries in a standard angiogram test. Instead, diagnostic testing should include stress echocardiography. This diagnostic test has proven to be a better tool than a standard exercise stress test for women. In terms of treatment, women who are suffering heart attack symptoms that are not caused by an obstruction often do better with beta-blockers than with calcium channel blockers. Other more effective treatments might include angiotensin-converting enzyme inhibitors and statin drugs, either alone or in combination. These treatments differ from what is usually prescribed for men.
Heart attacks in women present differently than in men. By understanding the different risk factors, warning signs, and best tests and treatments for women, heart attacks can be treated more quickly, minimizing damage to the heart muscle. Doctorpedia encourages everyone to talk to their physician about any unusual symptoms or questions about risk factors.
- Charatan F. (2003). Women with heart attacks have characteristic symptoms, says new study. BMJ : British Medical Journal, 327(7424), 1128. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1126867/
- DeVon, H. A., & Noureddine, S. (2014). 20 things you didn’t know about women and heart disease. The Journal of Cardiovascular Nursing, 29(5), 384–385. doi:10.1097/JCN.0000000000000129
Nan Kuhlman is an author, freelance writer, and part-time university professor based in Los Angeles, CA. She currently works full-time as a technical writer in Los Angeles and part-time as an online adjunct writing instructor. She has written for scholarly publications like the University of California, Davis Writing on the Edge and Chapman University’s Anastamos Interdisciplinary Journal, among others.