Most common heart attack signs in men and women

20 Sep

by Carolyn Thomas  @HeartSisters

Simple. Clear. Easy to understand. Each of these symptoms could be a warning sign of a heart attack. Notice that the unique symptoms listed on the right of this CardioSmart infograpic excerpt are most commonly seen in women.

But there’s more . . .  

These cardiac symptoms often come and go – sometimes over a surprisingly long period of time.  They’re not always severe. We may believe that heart attack chest pain must be described as “crushing”, but it’s often frequently described by women with words like pressure, heavy, burning, full or tight – not “crushing” and often not even as “pain”.

And 8-10% of women experience NO CHEST SYMPTOMS at all during a heart attack.(1)

Over 95% of female heart attack survivors report knowing something was “terribly wrong” in the months leading up to a cardiac diagnosis.

For example, an interesting cardiac symptom often reported by women is what we call “a sense of impending doom” (anxiety occurring along with shortness of breath that doesn’t let up).

What to do when these symptoms strike?

You know your body. You know when something is just not right. Seek immediate medical care if you experience troubling symptoms that feel unusual for you, especially if they persist over time or get worse.

Find out more about this CardioSmart infographic from the American College of Cardiology.

(1)  S. Dey et al, “GRACE: Acute coronary syndromes: Sex-related differences in the presentation, treatment and outcomes among patients with acute coronary syndromes: the Global Registry of Acute Coronary Events”, Heart  2009;95:1 2026.

IMPORTANT UPDATE:

January 31, 2016:   The American Heart Association released its first ever scientific statement on women’s heart attacks, confirming that “compared to men, women tend to be undertreated, and including this finding: “While the most common heart attack symptom is chest pain or discomfort for both sexes, women are more likely to have atypical symptoms such as shortness of breath, nausea or vomiting, and back or jaw pain.”

.

Q: What was the first symptom you experienced during your cardiac event?

See also:

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22 Responses to “Most common heart attack signs in men and women”

  1. Curious to the Max October 9, 2015 at 6:33 pm #

    A woman in my class was experiencing all the classic symptoms listed in your chart. The FIRST line of questioning the paramedic asked, after asking her name, medications etc. was about anxiety. Another paramedic reminded him she had vomited (in addition to sweating profusely, chest discomfort and jaw pain) and that’s when he stopped the anxiety questions.

    I was still alarmed that in this day and age they even went the “anxious route”.

    Liked by 1 person

    • Carolyn Thomas October 9, 2015 at 7:08 pm #

      Yoiks! I wonder if that paramedic routinely first asks all male patients experiencing textbook cardiac symptoms like vomiting, sweating, jaw pain and chest discomfort about their anxiety

      That “anxiety” question reminded me of a famous Cornell University study on medical students who were given case studies of both men and women. Each patient had all the risk factors for a heart attack, including the emotional stress of having just been turned down for a job promotion.The majority of the students referred the male patients to a cardiologist; the majority also referred the females to a psychologist. What does that tell you?

      Judy-Judith, you left out the best part of that story of the woman in your class – the part where you recognized right away that her symptoms could be heart-related, and you made sure she sought immediate medical help. Brava!

      Liked by 1 person

  2. MioMyo September 26, 2015 at 11:30 am #

    Hi Carolyn & all my heart sisters. Well, this is an update. Maybe my story & experience will be helpful for somebody with the same condition… Carolyn, I am not sure I post in the right place. If not, please feel free to moderate it! But this is probably a scary example of misdiagnosis… One more example.

    My “strange” condition turned to be a rare kind of arrhythmia — Long QT Syndrome. I am diagnosed officially now and this is a bit of relief from one side, as I know what’s going on. But, the other side, knowing you walk on the edge every day — is an awful feeling.. You know it. Also, I have to check my kids too, as this could be an inherited condition.. (I hope it is not).

    I’ve learned so much these months… For example, it turned out that at least one of the doctors who assessed me, suggested a diagnosis of cardiomyopathy and made a note about it in my file. Nobody told me. My present doc wrote in my file “They treated cardiomyopathy as a pericarditis though”. Shocking. My poor heart was struggling with cardiomyopathy and arrhythmia (LQTS is a kind of arrhythmia) but everybody told me “it’s pericarditis just take colchicine”… I did not believe that when I first read it in my chart.

    Also, I was suffering from a chronic pneumonia and now have a scar on my lung visible on CT. This pneumonia gave a complication as a cardiomyopathy. Nobody told me.

    At last, how I managed to get all the truth. I refused to have a family physician anymore. Just decided not to visit her and not to send any reports to her. I’ve always heard only one thing from her: “Nothing to worry about”. She saw all my awful ECGs, three positive stress tests (finally, the third one showed I have LQTS), knew about my syncope and that my heart skips beats. But nothing except “it’s alright” notes.

    Well, when I was taken by ambulance after blackout & a stopping heart, and they asked if I have a GP I said “No”. And this saved me. Now I am not an “anxious female” & “challenging lady” anymore.

    They referred me to the heart rhythm clinic. I’ve got 24 hours Holter & a stress test there and voila. I am diagnosed now and waiting for my defibrillator.

    I’ve no idea how long I will be waiting for it. My father did not manage to wait and died from sudden cardiac arrest at 49. I am 40… But here in Canada you can wait for ages, even if you risk to die while waiting. Anyway, I am so thankful to those docs & nurses who did not just throw me away but tried to diagnose me first. The nurses are our angels — they daily save our lives, and it’s not just words. One nurse, a pleasant middle aged man, his name is Crystal (here in the island hospital), did a print of my ECG where my QT was 528 milliseconds and showed this priceless paper to the doc on duty at the cardiac unit that day. Thank you dear Crystal & all the nurses who took care of me, explained to me everything finally and helped to go through the bad news. I have no chance to thank them. Please let me do it from your blog page dear Carolyn…

    I love all of you and wish you to stay positive — finally you will find help & support. Of course, with some efforts & actions, but it is possible. Even if you are “too young too female”, Do not give up.

    P.S. Sadly, but the docs who made a terrible mistake will never know about it.

    P.P.S.: Thank you dear Carolyn for your kind support & advice. Best wishes to you…

    Liked by 1 person

    • Carolyn Thomas September 27, 2015 at 10:39 am #

      What a relief that you finally have an accurate diagnosis. You might be interested in reading about Brugada Girl (aka Alicia Burns). She was diagnosed with an arrhythmia called Brugada Syndrome – not the same as Long QT of course, but her experience (years of delayed diagnosis, personal stories of getting her ICD implanted, getting her own children tested, etc.) might ring true for you, too. Best of luck to you….

      Like

  3. Ms. Maggie September 24, 2015 at 11:11 am #

    Sisters: I think that the view from a woman (women) is so important when discussing this subject that hits women so hard. With all that women do, we cannot afford to have our life soldier down for the count. Thanks for having all this powerful information for us concerning gender and heart disease and how it is not on most women’s health lists.

    And if it is in your family, you have to stop and get the info NOW. Go Red and fight it NOW. Now for another blog with heart with a bit of science and fun check out my sister’s blog at ALL THINGS HEART

    Liked by 1 person

    • Carolyn Thomas September 24, 2015 at 1:17 pm #

      Hello Maggie – you’re so right: most of us simply don’t have heart health on the radar until a cardiac event hits us or somebody we care about! Thanks for your comment, and for your link to your sister’s blog!

      Like

  4. Stephanie Hammar September 21, 2015 at 12:58 pm #

    While I can totally relate to all the above comments…my question is of a different “nature.” I have heard Dr. Sharonne Hayes (Mayo Clinic) discuss that actually “chest pain” is NOT the predominant symptom in men either. (The great infographic also shows 2 other symptoms for men). So, it begs the question, why do we have to “separate” women in a secondary sub group of other symptoms that we are practically begging others to know???

    Shouldn’t ALL of it be listed on 1 guideline sheet?

    And, another subject to ponder…. men and women can be different by their socio-biological responses, behaviors & perceptions, and therefore, what they actually report. An example she gave: When the doctor asks for our smoking history: men may say yes, while women say “no” due to only associating the act of smoking during specific social settings.

    Have at it Carolyn…..

    Liked by 1 person

    • Carolyn Thomas September 21, 2015 at 3:16 pm #

      Hello Stephanie – excellent questions! Do you happen to recall the source of Dr. Hayes’ statement about chest pain in men? (Mayo’s own website says: “The most common symptom of heart attack for both men and women is chest pain or discomfort.”) I’d be curious to find that study – I’ll be seeing her in person in a few weeks when I go to Mayo, so maybe I can pick her brains then!

      I do think a succinct one-pager would be fantastic – except that we already have decades of men-only (i.e. white-middle-aged-men only) cardiac research (and thus associated medical school curricula and textbooks!) educating docs on cardiac symptoms, diagnoses and treatments that have left some female heart patients tragically ignored. As Anne comments below: “If (women) do not report chest pains, then it’s Gomer time (Get Out of My Emergency Room). Or – as in my case – even with central chest pain, nausea, sweating, pain down my left arm! – women are STILL getting misdiagnosed even WITH Hollywood heart attack signs! I think it’s still useful to remind docs (and paramedics and all first responders) to remember that, as Dr. Nieca Goldberg’s book title says: “Women are Not Small Men!” (now re-titled The Women’s Healthy Heart Program (hardly as catchy a title, I’d say…)

      And I absolutely agree with your last statement: words DO matter! See my response to Anne (below) re the Kreatsoulas research on this very problem. Thanks so much, Steph…

      Like

      • Stephanie Hammar September 21, 2015 at 3:22 pm #

        Thanks Carolyn. Dr. Hayes spoke to us at a training conference about this. She did say that men complain of chest discomfort more than pain. If you are going to Mayo for the symposium, let’s pick her brain together!!!!

        Liked by 1 person

        • Carolyn Thomas September 21, 2015 at 3:35 pm #

          That makes sense! I’ve written frequently about this in women: there’s PAIN and then there’s PAIN. Women also may describe symptoms in the chest area as pressure, ache, heavy, suffocating, full, tight or burning – but not necessarily as pain. Are you going to the WomenHeart Symposium next month? What will you be doing there? Can’t wait to see you!!!! (I’m attending and speaking at Mayo’s 2-day Women and Heart Disease: A New Era conference panel on the Sunday). Please DM me, okay?

          Like

  5. Anne September 20, 2015 at 8:33 am #

    Where so many women get derailed in the ER and with the medical community is that they do not report chest pains and they do report that they are anxious or under a lot of stress. It’s all about timely accurate communication.

    An overworked, busy ER needs to triage. If you say that you deal with anxiety, depression and stress and do not report chest pains, then it’s Gomer time (Get Out of My Emergency Room). The medical community seems to NEED to hear “chest pains” and the marketing version of heart attack symptoms before they can move ahead with keeping a cardiac issue on the table.

    Perhaps they need to be able to chart chest pains or face the wrath to justify why further invasive procedures are necessary. Ditto with first responders. You may never even get to the ER if you cannot convince them of a heart related concern.

    Liked by 1 person

    • Carolyn Thomas September 20, 2015 at 9:50 am #

      Hi Anne! You are completely right about the stresses of doing triage, and the indignity of being viewed as a GOMER. I wrote about Dr. Catherine Kreatsoulas‘ research on just this subject: words matter when reporting symptoms in the ER.

      For example, she describes hearing ER physicians asking about chest pain, and women saying things like “Well, it’s not exactly chest pain, it’s more like an ache…” at which point, the ER doc writes NO CP (no chest pain) on the chart.

      I now advise women NOT to self-diagnose in the ER by saying “This is probably nothing, maybe just a pulled muscle…” but to say loudly and clearly: “I THINK I’M HAVING A HEART ATTACK!”

      But it’s also important to remember that for almost 40% of women, there is no chest pain during a heart attack.

      Many women are misdiagnosed even when experiencing, as I did, textbook Hollywood Heart Attack symptoms (central chest pain, nausea, sweating, pain down my left arm). But if chest pain (medicine’s favourite cardiac symptom!) is absent, your chances of being appropriately diagnosed can plummet. And if you say the word “anxiety”, you know what’s going to end up right at the top of your medical record.

      Like

  6. Anna in France September 20, 2015 at 7:11 am #

    My first symptoms were: exhaustion & breathlessness when walking distances which normally weren’t a problem, paired with an ache in my shoulders and arms. Having said that, I was getting stabbing and aching pains in my heart for several years.

    I eventually went to the doctor who diagnosed angina and sent me for blood tests the following day. That very day I had my heart attack – which I studiously ignored (“I’ll just pop to the market to get some bread and milk”).

    When I finally crawled home & told my husband I thought I might need to go to Casualty – I STILL evaded the reality by announcing after I had stuffed some things into a bag, that “actually I did not feel so bad after all & maybe I did not need to go to hospital.”

    Luckily my, by then, somewhat alarmed & exasperated husband coralled me into the car and thus my reluctant voyage of discovery began….

    Liked by 1 person

    • Carolyn Thomas September 20, 2015 at 7:42 am #

      Lucky your hubby was so persuasive! Your story would be hilarious if this kind of “treatment-seeking delay” behaviour weren’t so tragically common in women in mid-heart attack. One of my blog readers told me that her first heart attack symptoms hit about noon on Christmas Eve – but she had 12 people coming for Christmas dinner the next day so there was no way she had time to go to the hospital!! You might also enjoy reading this post on denial.

      Like

  7. Pauline September 20, 2015 at 6:20 am #

    The first symptom I ever had was shortness of breath when climbing stairs or walking on an incline.

    Liked by 1 person

    • Carolyn Thomas September 20, 2015 at 7:46 am #

      That’s very often the first symptom, Pauline – especially if it hits during activities that typically wouldn’t make us feel short of breath.

      Like

  8. Joyce Schleef September 20, 2015 at 4:53 am #

    No one believes me! They brush me off & send me home with “nitrostat, xanax, get counseling, eat right & exercise.” Chest pain at rest during the day & sometimes at night. Passed echo test for my Mitral valve prolapse (cardiologist said “barely leaking”—passed nuclear walking stress test and 3 EKG’s! I think I am losing my mind! Help!

    Like

    • Carolyn Thomas September 20, 2015 at 6:54 am #

      Joyce, you’re not losing your mind, although it sure can feel like it when you continue to have symptoms but no clear diagnosis. Right now, you don’t know if your chest pain is heart-related or not (it is quite possible it’s not – see “What is Causing My Chest Pain?”) It might be reassuring to remember that about 85% of all patients admitted to hospital for chest pain turn out NOT to have a cardiac problem. But whatever’s causing these symptoms needs to be addressed. Good luck to you in solving the mystery.

      Like

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