This article originally appeared in the April 2004 Harvard Heart Letter and is provided courtesy of Harvard Health Publications.

A look at heart attacks in women

Women and their doctors should look beyond chest pain when it comes to spotting a heart attack.

Heart attacks, like people, come in all shapes, sizes, and personalities. Some are big and bold, leaving little doubt as to what’s happening. Others are small and subtle, easily mistaken for something else.

Although hard-to-read heart attacks happen to both men and women, they are more common in women. One reason for this is that men’s symptoms initially set the standard for recognizing heart trouble. Now a growing body of research shows that women can experience heart attacks differently than men.

Understanding sex differences in heart disease is important. Heart disease is — and has been for years — the leading cause of death for women. Although it mostly affects older women, it isn’t rare in younger women. One in 10 of all women who die from heart disease or a stroke are under age 65, and this age group accounts for one-third of heart- or stroke-related hospitalizations. Even so, younger women and their doctors don’t necessarily suspect a heart attack even when all the signs are there.

Early warning
One of the most comprehensive surveys of women and heart attack symptoms was conducted by Jean C. McSweeney, professor of nursing at the University of Arkansas for Medical Sciences. She and her colleagues interviewed more than 500 women who survived heart attacks to learn what they experienced before and during the attacks. The women ranged in age from 29 to 95.

An astonishing 95% of the women said they noticed that something wasn’t right in the month or so before their heart attacks. The two most common early warning signs, fatigue and disturbed sleep (see Top 12 symptoms), were often severe. Some women, for example, said they were so tired they couldn’t make a bed without resting.

Chest pain, a common early warning sign of heart trouble for men, was far down the list for these women, reported by about one in eight. Those who did have it tended to describe it as pressure, aching, or tightness in the chest, not pain.

Even when their heart attacks were under way, only about one-third of the women in this study experienced the “classic” symptom of chest pain. Instead, shortness of breath, weakness and fatigue, a clammy sweat, dizziness, and nausea topped the list. The results appeared in the November 25, 2003, issue of Circulation.

Thinking outside the box
The McSweeney study isn’t the last word on women and heart attacks. The women surveyed had been treated at just five hospitals in Arkansas, North Carolina, and Ohio, and almost all were white. So it is possible that black, Hispanic, Asian, and Native American women, or those who live in the other 47 states or elsewhere in the world, might have a different constellation of symptoms. That said, this work is in line with earlier studies showing that heart attacks in women can look and feel different than those in men.

One take-home message is that some women may get an early warning of an impending heart attack in the form of excessive tiredness, disturbed sleep, or shortness of breath. Paying attention to these symptoms and getting prompt diagnosis and treatment just might stave off a full-blown heart attack. Some men also have early warning signals, with chest pain being the most common.

The other message is that women and their doctors need to think beyond chest pain when it comes to what women experience as a heart attack blossoms. Instead of writing off shortness of breath, fatigue, cold sweat, dizziness, and nausea as signs of something that will pass, everyone needs to give these symptoms a second look.