“It’s 2 a.m. and I think I might be having a heart attack. Right now I have a tight chest and pain in my left arm and in my elbow that comes and goes; early this week, I was having pain in my left and right legs. What should I do?”
“I’m sitting in bed and have been up for hours. For four days, I have been having upper right back pain up to the neck. I cannot turn my head left. Tonight I have pain in my elbow and a tingling all the way down my right arm and to my fingers. I’m only 29 and a healthy weight. I need some answers. Do I need to go to the ER?”
“I have most of these symptoms. My mom thinks I’m fine. I really think she doesn’t understand. I can be heading to a heart attack any day soon. And I’m only 14, almost 15 in a couple of days.”
These represent just a tiny sampling of the symptom questions that my blog readers often send me. My response to each of these is virtually always some variation of this statement:
“I’m not a physician, so I cannot advise you on your specific symptoms. Please discuss them with your doctor.
In some posts about heart attack symptoms (the ones most often likely to elicit those 2 a.m. pleas for help), I’ve decided to disable the comment feature entirely because I simply can’t bear responding with the trite “I’m not a physician…”
What I know about my readers is that it must be desperation that drives a person to reach out to a perfect stranger like me online, often in the middle of the dark night (when I’m fast asleep, halfway around the world, unlikely to even read their words for many hours). What each one is asking me for is reassurance. You’re fine. You’re not having a heart attack. Go back to sleep.
But what I do not and cannot know is anything at all about them. How could they expect me, a mere heart patient myself, to provide an answer to the plea, “What should I do?”
It’s sometimes tempting to outright dismiss a symptom described by a very young woman who tells me it hurts to turn her head to the left. Isn’t that complaint clearly non-cardiac in nature? Wouldn’t it be reasonable for me to respond: “It’s probably not your heart!”?
When I first went to Mayo Clinic in 2008 to attend the WomenHeart Science and Leadership Symposium for Women With Heart Disease, I met 45 other female heart patients taking this training, ranging in age from 31 to 71. Until that day, I’d never been in a room with that many women living with heart disease.
One of the women at Mayo revealed that her only heart attack symptom had been a persistent cough.
Another whose only symptom had been that her lips turned numb.
Yet even knowing this, I can’t possibly be suggesting here or during my women’s heart health presentations to any woman experiencing bizarre symptoms like a cough or lip numbness that she ought to rush down to the local Emergency Department JUST IN CASE she’s having a heart attack!
The often-surprising reality is that since 2008, I’ve heard countless descriptions from real-life heart attack survivors whose initial cardiac symptoms seemed equally bizarre.
And despite the insistence of some cardiac researchers who claim that men and women experience identical heart attack symptoms (especially chest pain), the lived experience of real female patients can appear to be much different. Women’s atypical cardiac symptoms have taught us that truth is often stranger than the most far-fetched hypothetical symptom when it comes to women and heart disease. See also: Researchers Openly Mock the ‘Myth’ of Women’s Unique Heart Attack Symptoms
While chest pain is indeed the most common heart attack symptom reported by both men and women, up to 40% of women report no chest symptoms at all in mid-heart attack. That means no chest pain, no pressure, no squeezing, no tightness, no fullness, no heaviness, no twinge, no burning, no bubbles, no squeaks. Nothing. Nada. Zero.
But ironically, it’s been estimated that even among those who are admitted to hospital with what does indeed appear at first to be heart-related chest pain, 85% of those turn out to be non-cardiac after all. That’s an awful lot of people going to Emergency and spending time in hospital beds who don’t have heart disease.
The important thing is to maximize appropriate care for people who do in fact have heart disease (no matter what their symptoms are), while minimizing unnecessary care for those who don’t.
It might help here to explain, dear reader, that there is indeed such a thing as catastrophizing, as I wrote about here.
You’ve met catastrophizers in your own life. I’ve met them. We all have: those who are preoccupied with even the most minor of medical complaints. These are the one-uppers in life: “You think YOU’VE got pain? Let me tell you about MY pain!” My friend Dave in Santa Barbara refers to casual conversations dominated by this kind of preoccupation as “the organ recital”.
“An anxiety disorder characterized by repeated complaints of chest pain, heart palpitations, and other sensations accompanied by intense fears of having a heart attack and of dying.”
He adds that in order to reduce anxiety, people with cardiophobia “seek continuous reassurance, make excessive use of medical facilities, and avoid activities believed to elicit symptoms”.
I have to tell you that it’s distressing for me to read comments from readers if I think they might be catastrophizers or cardiophobic.
But if I’m tempted to dismiss their fears outright, aren’t I doing precisely what so many medical professionals are already doing to far too many women? We know, after all, that women are still being under-diagnosed in mid-heart attack (and shockingly, under-treated even when appropriately diagnosed) compared to our male counterparts. For the latest confirmation of this reality, read the recently released 2016 scientific statement from the American Heart Association, or Cardiac Gender Bias: We Need Less TALK and More WALK
Yet simply by mentioning atypical heart attack symptoms here, am I unwittingly feeding the misplaced fears of catastrophizers and cardiophobes, those fears of being in imminent danger of dying any minute now from a heart attack? I may suspect that, at any given moment, many of these symptom descriptions are, in fact, not at all heart-related based on what I’ve learned so far about cardiovascular disease at Mayo Clinic and elsewhere – but I should never be the person to decide this.
How would you respond if you were in my hospital booties? Would you feel compelled to share what you’re really thinking, such as:
“Don’t worry – that pain in your legs is NOT likely a heart attack sign!”
A response like this, as you can imagine by now, could be right – or could be very wrong.
Whenever I raise awareness here by telling the public of the inherent factors that affect women’s chances of being accurately diagnosed, there’s a small possibility that some of my readers may become irrationally convinced that they, too, are experiencing a heart attack.
This possibility, however, doesn’t mean such public warnings aren’t both necessary and important. Going online to seek more information is a perfectly normal and predictable behaviour choice – whether we’re buying a new washing machine or wondering if those weird symptoms could mean a heart attack. There are credible online sites providing trustworthy information in all searches, and there are other sites that don’t deserve our trust. See also: Health Information Online: How To Tell the Trash from the Truth
The challenge for all seekers is to gain enough background information from credible resources to go out and ultimately make the best informed decisions. Many regions also provide a free 24-hour help line you can call (like our own 811 Health Link telephone service here in British Columbia where we can ask questions of a nurse, pharmacist, dietician or other health care professional). Find out if there’s a similar service where you live.
If it’s the middle of the night (or any time of the day), and your symptoms are frightening enough to make you ask for my opinion on what you should do next, please resist that urge and instead seek immediate medical help from a trained health care provider.
“I am not a physician, nurse or member of the medical profession. The information on this site isn’t intended as a substitute for professional medical advice. Please consult your doctor for specific help with your own health.”
Q: Is this site’s disclaimer enough to keep readers from asking for medical opinion?
- 2016 American Heart Association’s Scientific Statement on Women’s Heart Attacks
- What is Causing My Chest Pain?
- Oneupmanship: You Think YOU Have Pain?
- Cardiac Gender Bias: We Need Less TALK and More WALK
- Catastrophizing: Why We Feel Sicker Than We Actually Are
- 85% of Hospital Admissions for Chest Pain are NOT Heart Attack
- “How Does It Really Feel To Have A Heart Attack? Women Survivors Tell Their Stories”
- The Myth of the “Hollywood Heart Attack” for Women
- The Chest Pain of Angina Comes in Four Flavours
- When Chest Pain is “Just” Costochondritis