Having a heart attack felt nothing like I thought it would feel. For one thing, unlike sudden cardiac arrest, in which the heart stops beating and you stop breathing, during my heart attack (myocardial infarction), my heart continued beating, and I was walking, talking and conscious throughout despite horrific symptoms – so how could I possibly be having a heart attack?
Like most women, I’d never really thought about my heart – except maybe when running up that killer Quadra Street hill with my running group. Yet heart disease kills six times more women than breast cancer each year (in fact, it kills more women than all forms of cancer combined).
Women need to know all the potential symptoms of a heart attack – both typical and atypical. And by the way, I’ve stopped using the word “atypical“ to describe any non-chest pain symptom that women experience during a heart attack, because as paramedic and documentary filmmaker (“A Typical Heart“) Cristina D’Alessandro likes to say:
“Why are our cardiac symptoms called ‘atypical’ when women are more than half the population?”
I asked some female survivors to share their very first symptoms. Their heart attack stories may surprise you. If you need help translating some of the heart jargon, visit my patient-friendly jargon-free glossary of cardiology terms and abbreviations.
Sandra, age 37, USA: “I woke up at 3 a.m. and my first symptom was heartburn, even though I’d eaten nothing that might cause that. My husband brought me antacids, then a sharp pain went through my back and I told my husband I felt like I was going to die – all in the matter of one minute from the initial symptom. My heart actually stopped and I had to be defibrillated twice in hospital, and then was unconscious for four days. Three more trips to hospital afterwards, but no plaque, just spasms that felt like heartburn, nausea and sometimes chest pain (it is hard for me to tell the difference!) “
Lidia, age 56, UK: “The first symptom of my heart attack was heartburn – first time I’d had heartburn in 26 years since I was pregnant. I had no pain at all, but this heartburn would not go, no matter what I took for it. This was on my birthday, and I’d had too much to eat and drink! I Googled ‘heartburn’ – and up popped ‘heart attack symptom’ – so I took an aspirin and went to hospital, where cardiologists implanted a stent in my Left Anterior Descending artery (LAD). During the previous few months before this day, however, I’d been aware of occasional palpitations, but I’d put it down to too much coffee and not enough sleep.”
Laura, age 40, USA: “I was asleep and my symptoms woke me up. I had several simultaneous symptoms, but the first one seemed to be chest pain in the centre-left, somewhat under my left breast area. I’d never felt anything like it, so sometimes it’s hard to describe – it wasn’t sharp or crushing or burning, more like a dull pressure. I also had pain down the inside of my left arm that radiated up into the left side of my jaw and my left ear. I was very overheated, and I felt like I was going to throw up. The nausea and overheating faded, but the pain – chest, arm, jaw – stayed. In hospital, I was diagnosed with a heart attack caused by SCAD – spontaneous coronary artery dissection*, treated with six stents.”
Debra, age 42, USA: “I was under a lot of stress the week I had my heart attack. My first symptom was an odd squeezing sensation in my chest, as if someone reached out and grabbed my heart and squeezed it a few times. No pain – it really didn’t hurt. After my chest sensations went away, my upper back between my shoulder blades started to ache immensely. Later, I felt an odd numbing/tingling sensation move up my arm, which immediately made me worry and was the reason I went to the ER, as I knew this was a classic heart attack symptom. My chest sensations went away after I used my emergency inhaler (for asthma) as I had mistaken the beginnings of the heart attack as an asthma attack. But my back pain fluctuated, and arm tingling did not go away. In hospital, doctors found a blocked LAD (the dreaded ‘widowmaker’ heart attack) that they were going to stent. But after the first stent was implanted, an area in my artery near the stent dissected (tore) and I had to have emergency double bypass open heart surgery. I did not recognize my initial chest sensations and back pain as a heart attack and as a result I did not seek immediate help. Now approximately 40% of my left ventricle is damaged. I was also diagnosed with congestive heart failure a few weeks after being discharged for my heart attack.”
Dawn, age 49, USA: “I was asleep and woke up not being able to breathe. I felt an ache in my left shoulder blade. My throat felt ‘full’ and my lips were numb. These symptoms came and went until I ended up in hospital and had four stents implanted. But even before that night, I’d been feeling extremely tired; I kept telling my hubby I wasn’t sick, but something was wrong. I never had any chest pain at all until six months AFTER my heart attack.”
Sulma, age 61, Mauritius: “The sequence of events is so vivid in my mind. Before my heart attack, I had had some shortness of breath after exertion, like going upstairs. My first big cardiac symptoms were a discomforting epigastric pain and a tightening chest pain that woke me up at 4 a.m. from my sleep. This gradually radiated down the left arm, a numbing sensation. I started sweating as the pain grew in intensity during my trip to the ER, which took about 25 minutes. I was restless every second, and the pain in my chest became unbearable and tight. These symptoms persisted until I was given an injection and rushed to the Cardiac Unit for angioplasty and one stent implanted in my LAD. As it was placed, all the pain went away.”
Martie, age 46, USA: “There is a lot of heart disease in my family. My first symptoms were heartburn that progressed to a pressure on my chest. The pressure got to a certain point, but did not get progressively worse. I also had a strange aching feeling in my elbows. It was weird, like arthritis I think, that became worse with time. But the most prominent symptom I had, which did keep getting stronger and would not go away, was the little voice in my head telling me this was not normal. I wanted to mention this because it is my one piece of advice to all my friends: “Listen to that voice in your head!” When we got to the ER, when staff heard that I had both chest pain and this odd pain in my elbows, they took me right in quickly! Even before my first obvious symptoms, I had noticed a dead tired, flu-like fatigue, “tired to the bone through and through” as I told my son. I almost went home to bed after driving the kids to school (I would be dead now! I needed groceries first though!) My symptoms did change a bit – one would subside, and another would get worse. The only one that got much worse was in the elbows! I had to be air-lifted to a hospital with advanced cardiac care. Cardiologists there found a large unexpected arterial tear (SCAD: Spontaneous Coronary Artery Dissection*) and repaired half of it with three stents. They left the other half to heal itself. Three weeks later, they found that it had indeed healed.”
Sharon, age 43, New Zealand: “My heart attack started as I was walking across a flat lawn on my way to feed our goldfish. The pain struck out of the blue. I had no idea that a heart attack could present with pain in the back rather than the chest. My first symptom was a strong pain in between my shoulder blades, a lot like very bad indigestion but in my back instead of my tummy. A few minutes after the pain in my back started, I got very, very hot, then I felt nauseous. Then after several minutes, I felt the pain travel through into my centre chest, and then down my left arm to my hand. Like many others, that’s when I guessed that this might be serious. The pain kept increasing in my back until it was unbearable, but the other symptoms pretty much stayed the same until I was treated in hospital. Thank heavens for morphine – yay! I was diagnosed with a heart attack caused by SCAD* of the LAD. Two stents were implanted. They were tough days.”
Gloria, age 63, Canada: “I had a tremendous, dull, pressing pain in the centre of my chest, as if a walnut were being pushed into it. I also had numbness in my right shoulder radiating down my arm and felt as if the arm suddenly became weighted. Later, the same symptoms were manifested in my left shoulder and arm. Chest pain stayed, but the numbness in both arms gradually went away. This was replaced with blinding pain in between my shoulder blades. Once started, the back pain only got worse. I could no longer sit, stand, lie down or walk around. The pain was so intense it took my breath away. I remember thinking that these were signs that you could be having a heart attack. These events took place between 4 p.m. on Christmas Eve and about 11:30 a.m. on Christmas Day 2007, before I finally thought it was serious enough to get my son to drive me to our local hospital. These just didn’t sound like the classic cardiac symptoms I had heard of. I lost conciousness while the ER doctor was trying to convince me it was a gallbladder attack and not a heart attack. It took three days to stabilize me before I could be flown to the cardiac centre in Victoria, where I had two stents implanted. The previous two months had been unbearably stressful. I would get out of breath walking, but I just put that down to steep hills in town. I had put on weight, and the week before the heart attack, for some reason I gained 10 pounds. Maybe someone will read this and decide not to wait as long as I did.”
Diane, USA, heart attack at age 33: “My first heart attack was 23 years ago but I remember it as though it were yesterday. I had just turned 33 the month before it happened. I put my 3-month old baby to sleep in her crib, checked on my older daughter and went to the living room to relax before heading to bed myself. My first symptom was like a fist in the center of my chest, pushing and squeezing to get out. The pain felt as though someone was gripping me inside right in the center of the sternum and squeezing until I could hardly breathe. My left arm hurt from the shoulder to the elbow, then stopped and picked up hurting at my wrist into my hand. I started feeling very sick to my stomach and vomited until there was nothing left, but still continued retching. I was sweating like crazy. I woke up my husband, and told him I thought I was having a heart attack, but not really believing that was happening because I had no clue what the symptoms of a heart attack were. While waiting for the ambulance, I went from abnormal sweating to freezing cold. In hospital, they diagnosed a 98% blockage of the LAD, which they did angioplasty for. I spent 15 days in hospital. I had just given birth three months prior, but even during the pregnancy and afterwards, I had been getting that same feeling in my chest off and on. I had mentioned chest pain to the OB/GYN, but they told me that it was just amniotic fluid pushing my insides up into my chest, and that was the cause of the feeling.
“My second heart attack happened 10 years ago when I was 46. I was having ongoing problems with unstable angina so I had to have a stent implanted. The day after I came home from hospital, I walked into my living room and all of a sudden, I had this overwhelming feeling that something was terribly wrong. I told my husband to call 911. In hospital, they stabilized me and sent me to another hospital, where a cardiologist attempted to open up the new stent that had just been implanted. It had closed up, causing another heart attack. I went into cardiac arrest twice. I am now 56 and in need of bypass surgery for another blockage in the circumflex artery which they are unable to stent. Since I am not having symptoms, they are holding off on it.”
Kathi, age 55, USA: ” I awoke around 1:30 a.m. and felt pain down my right arm. It intensified as time went on, with the pain/tightness extending to my chest area. I had intense nausea and began vomiting and having bouts of rampant diarrhea in between. When I got to the hospital, the cardiologist found my LAD had collapsed without any coronary artery disease. While he was implanting two stents, he caused a hole in my artery, so had to put in a third stent. I believe that my heart attack was caused by stress and by an overdose of a variety of hormones prescribed for my chronic fatigue syndrome. Even before that night, I’d felt flu-ish with no energy, not unusual with Chronic Fatigue Syndrome. I didn’t feel quite right, but I had no clue what it was and because I have CFS, I thought it may be related to that. “
Monica, USA, heart attack at age 32: “One month prior to my heart attack, I was not feeling well with chest pains, lock jaw and fatigue. But my first real symptom was at 5 a.m. – pain in mid-chest radiating into my back and into my throat. I felt like I was being strangled, pain spreading into my throat and ears. The pain literally felt like 10,000 elephants sitting on my chest. In the ER, because of my young age and the fact that I weighed only 100 pounds soaking wet, they thought I was a drug user. I was later told I’d had a massive heart attack. I spent two days being stabilized before having a stent implanted, but instead of the stent, I was taken straight in for emergency bypass surgery. My heart now has severe damage to the left lower chamber. Last spring, 10 years after my heart attack, I had to go back into hospital to have an implantable cardiac defibrillator (ICD) put into my chest. I have named my ICD “Trigger”!
Allie, age 51, USA: “I‘ve had two serious cardiac events with different symptoms for each one, so I’ll tell you both stories. My first symptom in January was incredible fatigue. I was sitting in bed, watching TV and could suddenly no longer even hold my head up. The next day began six weeks of on-and-off symptoms of nausea, dizziness, back pain in my left shoulder blade (which eventually began to radiate through to my chest), profuse night sweats and feelings of being intolerably hot. I began having panic attacks (my first ever), feelings of doom, and severe anxiety. The back pain felt like a muscle knot. It seemed to hurt all the way through my body to my chest with that same soreness and knot feeling. My symptoms were not related to exertion. When I went to the hospital, I had to have emergency open heart surgery for a triple bypass.
But almost immediately after my bypass surgery, the bypass grafts began to fail. My chest pain this time felt sharp and pinching as if my clothes were too tight, then it moved up the left side of my neck. My throat felt full, and it was hard to swallow. My left jaw ached (like a dull toothache, or maybe having a piece of popcorn stuck). I also felt dizzy, hot, nauseated and anxious. Any activity or emotional stress brought on chest, neck and jaw pain, but other symptoms came on without any reason. These symptoms came and went for over two months and were ignored by my cardiologist because he said they were different than pre-bypass. Finally, I was correctly diagnosed and had two stents implanted to open the failed bypass grafts. Two new blockages remain. I also have Peripheral Artery Disease (PAD) which is usually associated with coronary artery disease and strokes. I had symptoms of this even before my cardiac symptoms began – which I ignored.”
Misty, age 26, USA: “I was 35 weeks pregnant and feeling really tired because we had just put up the new baby crib the night before. I went to sleep, but woke up to this weird constricting feeling in my lower throat, like I had a lump of something stuck there. The feeling went down to my upper chest and continued down to the lower chest area. It wasn’t pain, just more of a squeezing, restricting feeling. I then started to get a slight pain that felt like acid relux. I started to feel faint so I woke up my husband. I was sweating profusely, nauseated, had the chills and felt faint. And I also had a very weird tingling and numbness in BOTH arms from my shoulders to my elbows. We went to the hospital, where I was told that I’d had a massive heart attack caused by an aneurysm. It had exploded and made a tear in one of my heart valves, allowing blood to flow through the layers and squeeze the valve. The doctors say my body just couldn’t handle the stress of the pregnancy. I ended up having an emergency C-section and triple bypass surgery. I have also had an ICD (Implantable Cardiac Defibrillator) placed because my heart muscle has not healed the way they wanted it to. But even before that day, I’d been feeling tired and short of breath, and I had just blamed it on being pregnant. Now I can see all these issues as cardiac problems and not just pregnancy.”
Joyce, age 60, USA: “My heart attack happened on the stress-treadmill in the cardiologist’s office. He handed me a nitroglycerin tablet to put under my tongue. I had extreme shortness of breath but felt no pain that I remember. I had had some symptoms in the weeks before, such as tightness in the chest and extreme pain in my left shoulder blade. I also had these same symptoms months earlier, but dismissed them as just a pulled muscle after lifting heavy luggage. Even my doctor thought I had pleurisy or a virus, but sent my EKG ( with an unusual T-wave) to the cardiologist who wanted me to come in for the stress test. I was lucky to have my heart attack on the treadmill, because a subsequent angiogram showed no blockages, but a diagnosis of Prinzmetal’s Angina.“
Kim, age 52, USA: “I’d been feeling extremely tired for some time. One day, I was putting the vacuum cleaner away, and suddenly felt as if I’d pulled a muscle in my chest, in the center of my sternum, like a tight, heavy pain. I was sweating profusely and feeling nauseated. I had pain/tingling in my left arm, and then I blacked out. When the paramedics arrived, they gave me nitroglycerin which eased the symptoms temporarily. In hospital, I had to have two stents implanted and spent two days in ICU because of low blood pressure.”
Amy, heart attack at age 28, USA: “I had crushing chest pain while I was pregnant, along with sweating and nausea. I was told it was the baby kicking my diaphragm. These symptoms continued for two years, off and on, usually brought on by exertion. After pregnancy, I was told it was exercise-induced asthma, then pleurisy. Finally, after a bad episode (burning up and down my chest – like heartburn on steroids, sweating, nausea, vomiting, tingling in my arms and legs – both sides, stabbing shoulder pain and shortness of breath), I was finally sent for a stress test, where heart attack damage was found. By this time, even walking across the room or watching something emotional on TV (like a Hallmark commercial!) would set off symptoms. I was taken to hospital, but during my angiogram, I had a massive heart attack on the table. I had to be transferred to another hospital and had an emergency double bypass. **My unsolicited advice: don’t have an angio in a hospital that doesn’t also offer excellent open heart surgery. The balloon pump did quite a bit of damage to my arteries during the transfer. Since those first undiagnosed cardiac symptoms at age 28, I’ve had a second heart attack and double bypass surgery at age 30, nine cardiac stents and three iliac artery stents implanted at 30 and 31, and then triple bypass surgery at age 31.”
Kimber, age 46, USA: “My first symptoms felt like a blow to the chest, like a shotgun smack dab in the middle of my chest. It immediately took my breath away and knocked me backwards about 3-4 feet. I also had an intense drilling pain under my left funny bone. The symptoms did not let up. At the time, I was just sitting at my desk. Doctors found 0% plaque in my arteries – I was diagnosed with a coronary artery spasm from Prinzmetal’s Angina. I remained several days at two different hospitals. My first heart attack was on May7th and my second was on May 22nd.”
Gill, age 49, UK: “I had what I later found out was classic angina, severe tiredness and increasing chest pain, treated for all sorts of things, including inflammation of the sternum, but it got steadily worse over six months. I then had an angiogram that showed severe disease in two of my coronary arteries. I was treated with various medications over six months, but steadily worsened. Then doctors attempted a stent placement, which failed and I was sent home the same day with a small dissection (tear) which I was told would heal by itself. But two days after the dissection, while watching TV, I had increasingly unstable angina, unresponsive to nitroglycerin, with sweating and nausea. I went to the ER where I had a bigger heart attack, with crushing pain, pain radiating up into my throat and tongue, nausea, vomiting and sweating, plus pain in my left arm. These symptoms came and went, in between different drugs they were giving me. A further angio showed that the dissection had not healed but extended, and the artery was full of blood clots. I was then sent immediately by ambulance with police escort to a cardiac unit a couple of counties away, where I had four stents implanted. This did not cure the problem, however, so two months ago I had to have double by pass surgery.”
Nancy, age 44, USA: “I believe I had SCAD (Spontaneous Coronary Artery Dissection*) 10 years ago, but was misdiagnosed with costochondritis, 11 days postpartum. Two years ago on a Sunday afternoon, I had a strange spell of nausea, headache and faintness out of the blue – a combination of sick feelings that lasted a few minutes, and which struck me as unusual. I lay down and felt better. That was the day before more heart attack symptoms started after some heavy exertion, again due to SCAD. I think the artery must have torn a bit that Sunday, but it was not yet severe.
The next morning (my theory) the tear extended after physically demanding exertion, then I had the heart attack. I think this is important to clarify because one could conceivably prevent the dangerous extension of an arterial tear by avoiding exertion (if you’ve had the prior symptom of unusual faintness/nausea). Get medically checked out if you have that unsettling out-of-the-blue nausea/faintness feeling. Do not engage in physical exertion until cleared that your heart is okay.
I went to hospital with very painful central chest pressure, labored breathing, pain/numbness radiating to throat and arm, difficulty standing or talking. In the ER, my blood tests showed elevated troponin cardiac enzymes (confirming heart attack, which the ER doc initially diagnosed as anxiety). I was taken to another hospital where the dissection was discovered and I received two stents. Two days later, two more stents were implanted for an intractable spasm of the left anterior descending coronary artery (LAD). The pressure and pain from the LAD spasm felt more life-threatening than my dissection, maybe because it was a bigger artery?
But even before those events, for some time I’d had non-pain angina symptoms like chest pressure and shortness of breath. I thought it was just from exertion or allergies. It felt like your chest and breathing might feel when you exercise in very cold weather. I’d also had spells of chest tightness when awakening, which I just attributed to anxiety because we had a child health crisis going on.”
Erna, age 49, USA: “Late one evening, I was working on a website for my son-in-law when I started having some pain in my right arm and thought that maybe I had worked my arm too much with the computer mouse. But the pain started radiating into my shoulder and after this into my back. There was no pain in my chest. I thought it was time to quit, and I did some meditation. I had no memory of anything else until the next morning, when I awoke and felt awful. I could not breathe, my back hurt, and I felt like throwing up but could not. The symptoms got steadily worse and I called 911. The firefighters and paramedics who responded knew right away that it was a heart attack when they saw my EKG. When we got to the ER, however, the doctor told the nurses to take the EKG leads off because I was just having a panic attack. But the paramedics were still there and they insisted that my leads be placed on again, and that’s when they saw my pulse flip-flopping on the monitor. I was sent by helicopter to a different hospital where I had three stents implanted. It was very scary.”
Corby, age 51, USA: “My first cardiac symptom was anxiety and pressure in the upper chest – I tried to dismiss it as indigestion. (I also ignored the pain in the back – even months before, generally when I was feeling stressed). I had swelling in the hands and feet, was out of breath climbing stairs – I thought it was just the cold air. These symptoms came and went. Then I had a squeezing feeling, pressure in the center of the chest and towards the left but still felt like severe indigestion. My head and arms broke out into a cold sweat and felt clammy. I had nausea and the ‘dry heaves’. I was driving myself to work and decided to pull into the ER on the way. I had emergency bypass surgery for a blockage in my left anterior descending coronary artery (LAD) with a mammary artery graft.
This week, six years later, I just got out of the hospital again with a blood clot in my lung. I thought at first I was having another heart attack. The symptoms were crushing pain to the chest and numbness in the arm, a clammy feeling, cough, low grade temp. I am on blood thinners and they don’t know why this happened.”
And here’s my own story:
Carolyn, heart attack at age 58, Canada: “My first heart attack symptoms struck out of the blue while out for an early morning walk: central chest pain, nausea, profuse sweating and pain radiating down my left arm – so severe, that I had to stop walking and lean against a tree. It was this arm pain that frightened me. The chest pain felt oddly familiar: armpit to armpit, like a crushing burn right up into my throat – similar to what I’d often felt as a distance runner for 19 years when running up a long steep hill. But the arm pain was very unusual. The Emergency physician told me that all of my cardiac diagnostic tests were “normal”, and that I was “in the right demographic for acid reflux”, and that I should call my GP and get a prescription for antacid drugs. The E.R. nurse then approached my bed and sternly scolded me for asking questions of the doctor (“He is a very good doctor, and he does not like to be questioned!”) The question that I’d asked was this: “But Doc, what about this pain down my arm?” (Even I knew that arm pain isn’t a sign of indigestion). But I felt embarrassed and humiliated for making a fuss over nothing. I couldn’t get out of there fast enough. And when my symptoms returned, I just kept popping Tums and Gaviscon – because a man with the letters M.D. after his name had clearly told me “It’s not your heart!” My symptoms worsened for two weeks – but I was still able to go to work, drive my car, fly across the country for my mother’s 80th birthday) until I finally forced myself back to that E.R. – this time to a correct diagnosis (“You have significant heart disease!”) and a stent implanted in my LAD. Within months, I was further diagnosed with Coronary Microvascular Disease.”
Thank you to the 22 women who generously shared these compelling survivor stories here.
NOTE FROM CAROLYN: I wrote more about women’s varied cardiac symptoms i my book, “A Woman’s Guide to Living with Heart Disease” (Johns Hopkins University). You can ask for it at your local bookshop, or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from Johns Hopkins University Press (and use their code HTWN to save 30% off the cover price when you order).
© Carolyn Thomas www.myheartsisters.org
* Have you been diagnosed with Spontaneous Coronary Artery Dissection? Find out if you are eligible to participate in new SCAD research being done at Mayo Clinic.
This article was re-published on KevinMD.