by Carolyn Thomas ♥ @HeartSisters
When Dr. Jean McSweeney from the University of Arkansas for Medical Sciences interviewed hundreds of heart attack survivors, she discovered something surprising: 95 percent of the women she interviewed actually suspected something was very wrong in the months leading up to their attack.
But even these early warning prodromal symptoms didn’t necessarily send women to the doctor, as reported in Dr. McSweeney’s study, published in the medical journal, Circulation.(1) And for those women who did seek help, doctors often failed to identify their problems as being heart-related.
If you experience the warning symptoms of impending heart attack listed below – especially if the feelings are new, worse, unexplained, or you have other heart disease risk factors – call your doctor. And if they’re increasingly severe, or if you experience multiple symptoms at the same time, call 911.
Dr. McSweeney adds:
“Women die sitting at home. Any E.R. would prefer that you come in and not have a heart attack than have a heart attack at home, waiting to see if you get better.
“We could do a lot to give women longer lives and better-quality lives if we could help them recognize these heart problem signs before the first attack.”
Symptom: Unusual fatigue
♥ As Early Warning: Wake up tired. Difficult to carry out usual activities; gets worse over time.
♥ As Sign of Impending Heart Attack: Overwhelming exhaustion – too tired to do anything.
Symptom: Shortness of breath
♥ As Early Warning: Winded with little exertion. Improves when you stop.
♥ As Sign of Impending Heart Attack: Often the first symptom; continues or worsens.
Symptom: Mood changes
♥ As Early Warning: Fleeting feelings of anxiety for no reason. Goes away.
♥ As Sign of Impending Heart Attack: Anxiety occurs along with shortness of breath and doesn’t let up; what we call a “sense of impending doom”.
Symptom: Digestive changes
♥ As Early Warning: Frequent indigestion.
♥ As Sign of Impending Heart Attack: Terrible heartburn, often with nausea and vomiting.
♥ As Sign of Impending Heart Attack: No strength – like having the flu.
Symptom: Sleep disturbance
♥ As Early Warning: Trouble falling asleep or staying asleep.
Symptom: Chest discomfort
♥ As Early Warning: Pressure, pain, heaviness, fullness, ache, burning, or discomfort (like a pulled muscle). Fewer than 30% of women reported early chest discomfort, a hallmark symptom in men.
♥ As Sign of Impending Heart Attack: Common, usually through chest or back. May or may not be the “Hollywood Heart Attack”: crushing chest pain, pain radiating down either left or right arm. Carolyn’s Note: remember that in at least 10% of heart attacks in women, there are NO symptoms of chest discomfort at all.(2)
Symptom: Other pains
♥ As Early Warning: Aching arms and hands; may have numbness or tingling (right, left or both)
♥ As Sign of Impending Heart Attack: Discomfort and/or pain in jaw, upper back, shoulders, neck, right, arms (left, right or both)
♥ As Early Warning: Headaches and periods of blurry vision
♥ As Sign of Impending Heart Attack: Cold clammy sweat, pale skin
♥ As Early Warning: Symptoms can come and go, but may increase in intensity and number as heart attack nears.
♥ As Sign of Impending Heart Attack: You may have six or more different symptoms that become more intense and pile on top of one another.
♥ ♥ ♥
* In Dr. McSweeney’s research, women heart attack survivors identified these early warning prodromal symptoms in the weeks/months before a heart attack:
- unusual fatigue (70.7%)
- sleep disturbance (47.8%)
- shortness of breath (42.1%)
- chest discomfort (29.7%)
The most frequent acute symptoms reported during a heart attack were:
- shortness of breath (57.9%)
- weakness (54.8%)
- fatigue (42.9%)
- Acute chest pain was absent in 43% of women during a heart attack
♥ ♥ ♥
(1) Jean C. McSweeney. “Women’s Early Warning Symptoms of Acute Myocardial Infarction”. Circulation. 2003; 108: 2619-2623 November 3, 2003.
(2) 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 20–26.
Q: Did you experience early warning symptoms before your heart attack?
I wrote more about women’s typical, atypical and early warning heart attack symptoms in my new book, “A Woman’s Guide to Living with Heart Disease” (Johns Hopkins University, November 2017).
How Does It Really Feel To Have a Heart Attack? Women Survivors Tell Their Stories
Is it a Heart Attack – or a Panic Attack?
Too Embarrassed to Call 911 During a Heart Attack?
Yale Heart Study Asks Why We Wait So Long Before Seeking Help in Mid-Heart Attacks
♥ PLEASE NOTE: I am NOT a physician and CANNOT advise you if you are experiencing any of these symptoms. Please see your doctor for a competent medical opinion if you are. DO NOT LEAVE A COMMENT HERE EXPLAINING YOUR SYMPTOMS. If they are unusual for you, do not hesitate to seek medical help. Read my site disclaimer for more info.
25 thoughts on “How women can tell if they’re headed for a heart attack”
For about 3 weeks I have had weakness in my left arm! I can still do everything I was doing just feels weak. It’s more in my forearm area. The last 3 days under my left breast there is a pain all day actually kinda feels inflamed too, sometimes the pain goes clear through to my back.
Hello Kira – I am not a physician so cannot comment on your specific symptoms. Please consult your physician.
This is the best blog to read about heart attack symptoms. This is very important to know.
I forgot to mention in my comment (below) that people who carry fatty weight under their breasts are in many cases causing “dependent atelectasis”, because the weight is directly on top of the diaphragm which isn’t able to spread apart with each breath, thus not allowing the lungs to fully expand. A low oxygen (02) sat on a heavy person is often the reason as their lungs are not able to take 02 in. I have seen this happen. Heart pain happens when the heart is not receiving enough oxygen through the arteries whether the coronary arteries are stenosed or not. Thank you
I agree completely. 4 of my girlfriends, all with very responsible jobs, at ages of barely 50 have had heart attacks (lived fortunately).
I sat at home one morning feeling a pain in my chest (I don’t get indigestion). I have been an RN for many years and in cardiac but I sat there, wondering if I should do something…I suddenly “kicked myself”, got in my car and drove to the closest emergency room. Well, I didn’t have indications of a heart attack, but I went; I was so used to taking care of others, I didn’t count. Dumb! YOU have permission to call 911 or go to the ER whenever you are concerned….and don’t forget that.
As an RN I know we want to see you alive with nothing wrong, rather than having you wait because you felt you shouldn’t “bother” someone. It’s those “someone’s” jobs! You are NOT bothering us. I went, you go if you have the slightest concern.
I also want to add that many of the symptoms listed are related to lack of oxygen. Women especially tend to take shallow quick breaths. Stop and notice – are you using your abdominal muscles to breathe or are you breathing using your chest? You must retrain yourselves to breathe using your abdominal muscles to get nice deep breaths with enough oxygen to feed your vital and all organs.
Your heart is a muscle….it needs oxygen. Slow down, notice how you breathe. Notice if you give yourself time to exhale that carbon dioxide that needs to leave your body when you passively exhale. Quick, short inhales give you less oxygen and leave less time for the exhale part of breathing. You don’t want a buildup of CO2 (carbon dioxide) in your bloodstream….it too will travel through your bloodstream starving your body of oxygen. Relax, breathe properly, inhale AND let your lungs have time to exhale that CO2, don’t rush your breathing process.
Newborns are born using their abdominal muscles to breathe, we see their abdomens rising and falling at birth. Breathing correctly should be natural like this. The oxygenated saturation of your arterial blood (the blood that is pushed from your heart with every heart beat under the power of your blood pressure) is extremely important to your heart health. Known commonly as your SAO2, usually measured by the “clip” put on your finger which measures your peripheral oxygen saturation (areas outside your heart, like hands, arms), and gives a good estimate of your internal oxygenation.
I am an RN, I cannot give you medical directions other than to call your doctor, or, 1st if you are having chest pain, call 911. I have simply explained why correct breathing is imperative for your heart to function. Your brain also. Your oxygen travels in your arterial bloodstream, and takes oxygen to all parts of your body.
Please notice your breathing, talk to your doctor if you have difficulty breathing…..you need to breathe correctly to oxygenate your entire body or the cells that compose your body will be damaged. And again, never hesitate to call 911 if you are feeling “not right”. It is their job to help you, it is not an inconvenience and never be embarrassed to call 911 if you have chest pain, feel your heart or your breathing is feeling different or if you have the symptoms of fatigue and/or the other symptoms listed in the article above.
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Thank you for the good advice, Becca, on both effective breathing plus of course “never hesitate to call 911”. Treatment-seeking delay behaviour in women (yes, even in mid-heart attack) is in fact so common that many researchers studying this deliberate and dangerous delay have reported a number of very familiar excuses we come up with that can end disastrously. So it’s good to have an RN urge women to come into the ER! Here’s a post I wrote that summarizes a number of studies’ conclusions specifically on why women persist in engaging in women’s treatment-seeking delay behaviour. PS: In answer to your question about why your comment did not appear immediately on my site: all reader comments here are moderated before publication. Sometimes this happens fairly quickly (within a couple of hours depending on if I happen to be at home and also happen to be on the computer) and sometimes not for a day or two depending on my ongoing symptoms. In your case, you left your (first) comment at 11:53 a.m. and my response was at 1:23 p.m. I’d say 90 minutes is pretty darned efficient, considering. Thanks again…
I had a few of these symptoms. Women beware!
I have rheumatoid arthritis and fibromyalgia. I have most of those symptoms anyway. Last month, I went to the ER twice because chest pain was so bad. The doc thought it was probably costochondritis, but she gave me a referral for a CT coronary angiogram, which happened today. I had reduced my pain meds before the pain got bad, and once I increased it again it reduced again. There is a strong family history of heart disease on my dad’s side of the family. He died at 62. He had arthritis in his left shoulder and heartburn. He complained about both to my Mum the day he died. She never really forgave herself because she thought it was just his normal symptoms and went to work. That is what really worries me. That the symptoms I already have will mask coronary symptoms.
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Hello Andrea – as in Robin’s comment (below), your concerns that a pre-existing non-cardiac condition may mask cardiac symptoms is a common one. It was entirely understandable why your mother would have interpreted your Dad’s complaints (which she’d likely been hearing for years) as simply his “usual” problems, not heart-related. It’s tragic that she was unable to forgive herself for something that was a perfectly normal response. You didn’t mention if you have the results of today’s angio yet. If that doctor suspected costochondritis, you must have received a treatment recommendation. Read this for more info on that condition. It might reassure you to know that, although your Dad died young at 62 (same age as my own Dad, coincidentally), a family history of heart disease is defined as a Dad (or brother) who had a cardiac event before age 55, or a Mum or sister before age 65. Aunts, uncles, grandparents don’t count as defining a family history that impacts your own risk of heart disease. Right now, you simply don’t know if any of your symptoms are heart-related, but worrying that they might be will rob you of today. See your physician. Best of luck to you….
I was seeing my doctor every four to six weeks for over a year before my final heart attack. Very thin and active, but I was a light smoker and asthmatic. Shortness of breath I have lived with all my life but I was seeing my doctor because I was waking up unable to breathe. Their question to disregard my problem was: did I add more pillows and it would go away. I sleep face down with no pillow. When doctors said fine you are a stomach sleeper, they ignore everything you say as if you don’t understand.
I saw my doctor four weeks before my AMI (acute myocardial infarction – heart attack) and was told to increase the usage of the inhalers for chronic obstructive pulmonary disease. I’ve had acute bronchitis since the age of 7. Are doctors going to start telling children that they have COPD? I started smoking early because I found I had fewer bronchial attacks from the perfumes and smells on others, very smell-sensitive.
I was doing what I was told and was dismissed by the doctor as I was a smoker. Xrays and test say that I have acute bronchitis and maybe early onset of COPD. But cardiac testing says that I had been having small untreated heart attacks for over a year, and one major one in my Left Anterior Descending artery before the final. This is the reason for the massive irreversible and progressive damage.
I’m not angry any more about it, but the need to add that if you’re not overweight and unhealthy, don’t bother. Going in was just a waste of my time and money. I paid for my care out of pocket, doctor visit was a drop in the bucket but the COPD medications cost me $200.00 upwards. Meds that if they worked I wouldn’t be here now.
Robin, you raise some interesting issues, most notably that patients often present to their doctors or to the ER with multiple health issues. So it’s not unusual in the minds of docs who meet a smoker complaining of breathing difficulties who has had acute bronchitis since age 7 to automatically go directly to those issues as the likely culprits. But you are living proof that even those with life-long bronchitis can still be having a heart attack.
I had a stress-induced heart-attack. The Dr. did a cardiac cath and an echocardiogram. (No blocked arteries) I was put on a medication regime of Coreg, 325mg aspirin, 20mg furosimide. Also attended cardiac rehab, but still experienced chest pain. The Dr. says my ejection fraction went from 15% to 50%. I’m still having the same symptoms before my heart attack. Last night, it felt like heavy pressure on my chest. Confused! Don’t know what to do.😪
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Hello Debra – I’m not a physician so cannot comment specifically on your symptoms, but I can tell you that something is causing them. Right now, you just don’t know if they are heart-related or not (you didn’t mention how long ago your heart attack was, or whether your doctor prescribed nitroglycerin for angina or not). Make an appointment with your physician to talk about these symptoms.
I guess I was lucky… I thought I was having allergies and asthma… what it was was shortness of breath and chest and arm pain. By the time I talked myself in to the ER it was detectable through blood tests and EKG. I was taken for a cath and stents because a nurse pointed it out to the Doctor.
The residual effects of this shocking chain of events has been retirement and terrible side effects from medication. So, I went from a relatively healthy working woman to one in a state of flux. My heart attack was 7 months ago and fortunately I am not letting remarks like, “You’re not getting well fast enough” from my Dr. get me down.
When you earnestly report health issues, you become very aware that men approach women’s health differently than they do men’s because we are more likely to want them to listen not react.
I am improving but not without help. Your Heart Sisters site has been really important to my state of mind because you have let me know it is okay to have feelings… and they are valid!
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Thank you Carol for sharing your unique perspective. Good for you for talking yourself into going to the ER! A disturbing American Heart Association report a few years ago found that fewer than half of women surveyed said that they would call 911 if experiencing cardiac symptoms. Treatment-seeking delay behaviour is common – and potentially deadly – so I’m always glad to hear from heart patients like you who decided to seek help (even though you chalked up your symptoms to allergies/asthma!) Whatever the diagnosis, what you were essentially saying was “I know my body, and something is very wrong!” I’m wondering if your doctor referred you to cardiac rehabilitation program, post-discharge?
I had all the symptoms for 3 yrs. Every doctor’s appt, my blood pressure was normal. Finally in March 2015, a voice in my head told me if I didnt go to the hospital, I wasn’t going to make it. So still being in denial, I drove myself to the hospital. I was admitted. By the time I got to my room, a cardiologist came in to tell me I had a 95% blockage in my main heart artery. So stent surgery we went. So for the next 4 months I was in Cardiac Rehab therapy. I did well again.
Then in September 2015, I felt something was not right. But the next day I had an appt with my cardiologist. Well the next morning, I felt really bad. So again I went to the ER. Found out I had another 95% blockage just below the stent. They gave me a double bypass to save my life. I am truly humble to know I’m still here. I thank God for talking to me. I will always lesson to my instincts.
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Thank goodness you listened to that “voice in your head”, Lonet. I hope you’ve been well since that last hospitalization. You mentioned that your blood pressure during every doctor’s appointment was always ‘normal’ for those three years. Blood pressure, even during a cardiac event, can actually be normal, high, or low.
The Veterans Administration does not seem to know ANY of this!!
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This is a good article, Carolyn. For many years (8 at least) I had symptoms such as tiredness upon waking, severe left arm, jaw, upper back pain, etc. I would tell doctors but no one took it seriously. They diagnosed it as everything BUT WHAT IT ACTUALLY WAS. I finally had my heart attack in the hospital and that was when I had the “elephant on my chest”.
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Hi Sharen – EIGHT YEARS!?!??! Too bad none of your physicians during that time consulted with Dr. Google to look up “fatigue, arm, jaw, upper back pain” – because there’s likely one one search result that would have popped up.
Such a clear and concise list of early warning and immediate symptoms, Carolyn. Thank you!
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Thanks Denise – I think Dr. McSweeney’s work on prodromal symptoms in women should be taught in med school!
I had chest pain that would wake me up at night but a stress test was normal. About a year later, I started having crushing chest pain that I would almost compare to labor pain. I went to the ER and had a troponin test and EKG. I was told everything was fine and that I was having anxiety. The doctor suggested I go home and have a glass of wine!
Luckily I worked for a cardiology office as a receptionist. I told my boss that if this was anxiety, I was taking crazy to a whole other level. He agreed to do a cath and immediately found a complete blockage. I also had arterial spasms which he thought was causing a lot of the pain.
If you think something is wrong, please be your own advocate and keep pushing for an answer! Your life depends on it.
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“Go home and have a glass of wine!” Wonder how often ER docs say that to males who present with your cardiac symptoms, Mardi. What if you hadn’t been working for a cardiology office (like the majority of heart patients)?! Thanks for sharing your story – and great advice.
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