Women’s early warning signs of a heart attack

~ Carolyn Thomas

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 rushing to the doctor, as reported in Dr. McSweeney’s study published in the cardiology journal, Circulation.(1)  And for those women who did seek help early, doctors often failed to identify their problems as being heart-related. 

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%) NOTE: Acute chest pain was absent in at least 10% of women during an actual heart attack. (2)

If you experience the warning symptoms 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 severe, or you have signs of an impending (likely coming soon!) heart attack, 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.”

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.

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.

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”.

Digestive changes

♥  As Early Warning: Frequent indigestion.
♥  As Sign of Impending Heart Attack: Terrible heartburn, often with nausea and vomiting.

Weakness

♥  As Sign of Impending Heart Attack: No strength – like having the flu.

Sleep disturbance

♥  As Early Warning: Trouble falling asleep or staying asleep.

Chest discomfort

♥  As Early Warning: Pressure, pain, heaviness, fullness, ache, burning, or discomfort (or like a pulled muscle)
♥  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)

Other symptoms:

♥  As Early Warning: Aching arms and hands; may have numbness or tingling (right, left or both); headaches and periods of blurry vision
♥  As Sign of Impending Heart Attack: Discomfort and/or pain in jaw, upper back, shoulders, neck, right, arms (left, right or both); cold clammy sweat; pale skin

Overall

♥  As Early Warning:  Symptoms come and go, but may increase in intensity and frequency as attack nears.
♥  As Sign of Impending Heart Attack: You may have different symptoms that become more intense and pile on top of one another.

♥    ♥     ♥

(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 signs of your heart attack?

.

NOTE FROM CAROLYN: I wrote much more about adjusting to becoming a patient in my book, “A Woman’s Guide to Living with Heart Disease” . You can ask for it at your local library or favourite 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 20% off the list price).

 

See also:

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?

Downplaying symptoms: just pretend it’s NOT a heart attack

 

♥ 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 your symptoms are unusual for you, do not hesitate to seek immediate medical help. Read my site disclaimer for more info.

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Published by Carolyn Thomas

21 thoughts on “Women’s early warning signs of a heart attack”

  1. My symptoms were pain in both arms in the front near where they connect to the body. I tell people it feels like I did a bunch of dumbbell curls, overhead presses and chest presses and was just in major muscle fatigue.

    Also, eventually I was exhausted on the day of from doing nothing, my arm pain started like almost a week prior, I had a yearly physical scheduled about a week beforehand and my newly assigned male physician told me I probably just was out of shape. Yes, I’m overweight but I regularly worked out enough to not think that was it.

    Also, I was giving plasma regularly for like 8 months at that point and one of my symptoms was seeing a gradual RISE in my diastolic blood pressure. I didn’t see any mention of that but because I have it usually at the same time of day and such, I was able to have a history of what happened in that respect. On the day of, my BP got to 200/105.

    Anyways, I had my dad take me to the ER. I was asked ‘why not an ambulance?’ Well, stubbornness and knowing they cost so much, and I didn’t think I was having a heart attack.

    So, I had a 90% blockage of LAD. Got a stent. Also, I do have a history of high familial cholesterol. It’s been a year and I’m in a better place working on getting in shape.

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    1. Hello Paula – first, I’m so glad you’re feeling like you’re now in a BETTER PLACE compared to a year ago. I suspect that it takes a full year for most heart patients even to make sense of a diagnosis that makes no sense!

      I was thinking while reading about your experience that all of the decisions you made at the time seemed perfectly reasonable! For example, you already knew what major muscle fatigue from working out feels like, so attributing your cardiac symptoms to that reason just made sense. You didn’t call an ambulance (cost, stubbornness AND most of all, you’d been told by a person with the letters M.D. after his name that your symptoms were NOT heart-related – so that decision made sense at the time, too.

      The trouble is that – especially in women – we tend to reflexively minimize problem symptoms. This is remarkably common, and has been blamed for women’s traditionally poorer cardiac outcomes compared to our male counterparts. I hope you keep up the great work you’re doing know to stay healthy!

      Take care. . .♥

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  6. Chills all over the body is a sign of beginning angina pectoris. I had it and my brother had it. He went to a doctor, who did not make an EKG, but gave him antibiotics, saying he is getting the flu. He died the following night of heart attack. He was only 54 years old and single. I myself had 3 bypasses (age 37 years) and 8 stents in one of the bypasses. My brother lived in Finland and I live in Germany. So I had more luck. I am 70 years old now and I feel good.

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    1. Hello Mirjami – such a tragic story about your brother. My condolences on this sad loss. I have read the same report from other heart attack survivors (flu-like symptoms, including chills and cold sweats as early symptoms).

      I’m glad you survived all of your cardiac events and are feeling good these days! It’s lovely to hear from you again.

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  7. When I read it again, I recalled that those were my symptoms before my heart attack…My God…it was so intense…and the pain in the right arm…like death…and ‘going’ away…and that feeling of freedom…and lots of love from someone somewhere…and opening my eyes so confused…Yes…it is a tremendous experience…

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  8. Carolyn…I had two stents placed in early January, luckily prior to a major coronary event, but did have warning signs as you wrote about this week. I was immediately placed on many medications, including Plavix and aspirin.

    In March I suffered from a major internal gastro bleed with four iron infusions and a blood transfusion…hospitalized for five days… so weak I could not function. Had scope after scope, CT scans and others since to no avail. The bleed has yet to be found.

    The culprit is Plavix and aspirin but was warned by cardiologist that if I miss even ONE dose of Plavix, I could die from clots forming in stents with subsequent massive heart attack. On the other hand, I continue to bleed internally…just recovering from latest one with a final small jelly bean camera test to come.

    Then perhaps surgery to fix the damaged area. This ALL caused by the drug that’s supposed to help. Have you heard of any other cases such as this and, if so, can you offer any advice as to what to do? Damned if I continue with Plavix… damned if I don’t. Research also shows an increase in fatality within three months of stopping Plavix. Help!

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    1. Jackie, that is quite the dilemma. I’m not a physician, but I can tell you that anti-platelet drugs like Plavix and aspirin do help to prevent the formation of dangerous new clots inside the stents. They’re considered to be lifesavers, post-stent. Current guidelines suggest prescribing 6-12 months of this dual anti-platelet therapy (DAPT), but as you are clearly demonstrating, they are not without risk.

      You are in a high-risk category for bleeding. Is your cardiologist aware of your March hospitalization? You need to sit down with a cardiologist right away to discuss your use of Plavix or other anti-platelet drugs. This report (by Up To Date, a trusted resource for physicians) suggests:

      “Patients at high bleeding risk started on DAPT are considered for treatment of less than 6 months duration. In these patients, we individualize care (duration) taking into account the relative risks and benefits of DAPT.”

      Print this off to discuss with your cardiologist, a.s.a.p. Best of luck to you…

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  9. I have another weird symptom to add to this list. Both a close friend and my husband had the same thing – they itched like crazy all over their bodies! For days.

    My friend had a mild heart attack while in rehab after hip replacement surgery. She had blockages and they put in stents and her itching went away.

    My husband was itchy for days, then his arm swelled up and was tired. He apparently did have a heart attack according to blood tests, but they did lots of tests and couldn’t find anything specific. He’s going to have more in the next month. He already had bypass surgery years ago.

    So if you are tired and you get itchy go to the ER!

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    1. Hello Julie! I’m not a physician but I can say that I have read that there can be a link between heart disease and certain skin conditions. For example, Janeway lesions – small hemorrhages on the palms and soles – are commonly seen in cases of acute infective endocarditis, or skin nodules seen with sarcoidosis, or skin lesions associated with myocarditis seen in Lyme disease. But all-over body itching as a symptom of heart attack? That’s a new one for me!

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      1. I read it with full concentration. The information about the heart is so informative. Thanks for sharing.

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  10. I did not have a heart attack but would have if we hadn’t caught my condition when we did. I had fatigue every day for several months with shortness of breath and a tightness in my chest every time I did something as simple as walk from the car into a store. I chalked it up to being overweight and out of shape and also to stress. My mom died and my son was injured in a car accident in the space of a week and I ended up having to drive him everywhere for several weeks, like to college every day, on top of everything else in my life.

    Fortunately I mentioned the chest symptoms to my family doctor and she referred me to my husband’s cardiologist. I was annoyed when they called to schedule a stress test. I said I didn’t think it would show anything because I had had one years before and it only told me what I already knew, I was overweight and out of shape.

    The gal on the phone suggested I at least consult with the cardiologist and I’m glad I did because she convinced me it could be my heart. Out of 5 risk factors, the only one I didn’t have was that I don’t smoke (the others were family history, type 2 diabetes, obesity, and sedentary lifestyle). I had not thought of it that way. We did a stress echocardiogram and I was spent after about 3 minutes on the treadmill. I lay there gasping for breath while they took the images, hating myself for being so out of shape.

    At the follow-up visit she told me she was concerned because I “didn’t walk well” and she really couldn’t tell from the images what was wrong. She said she wanted to do a cath within the next 2 weeks. That was when I realized we might be dealing with something more serious than I thought. I blithered, “But — but that’s so invasive!” By the time I got into the cath lab, I knew that she was right and that something could really be wrong. Turned out to be a 99% blockage in the LAD and I received a stent. The interventionist told my son, “I did not save your mother’s life, but I did save her from a future heart attack.” I disagree, I think he did save my life. Losing 37 pounds and cardiac rehab after that helped too.

    I think women and maybe men too stay at home with symptoms because of denial. I consciously thought, I can’t have heart disease. That happens to other people . . .

    The funny thing was that a month after the stent (I’ve since gotten another one, again avoiding a heart attack, and again in the LAD), I ended up back in the ER with chest pains. It turned out to be my gall bladder and I have to say it was worse dealing with that than the heart problem! I was told I have a “large gallstone.” The doctors wouldn’t let me have surgery because I was on Brilinta and it was too soon after the stent. Fortunately, my gall bladder calmed down after awhile and I haven’t had any problems since, but I know it could act up again at any time.

    I guess what I want to say is, Denial is a strong force, but don’t ignore symptoms. Trust your instincts. Time is muscle. Call 911. And don’t be afraid to go back to the ER with new symptoms. It was as important to find out it was “just” my gall bladder as it would have been to find out if it had been my heart. Everything in the body works together.

    Thanks Carolyn for this great website! I so appreciate it and you!

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    1. You are so right, Meghan! Denial IS a strong force. I wrote more on this very common phenomenon, especially during a crisis: “Denial and Its Deadly Role in Surviving a Heart Attack” I think the other very powerful factor at work in denial is that we would much rather have something mild and benign going on, thank you very much…

      Every woman reading your comment should take your advice if/when distressing symptoms hit: Trust your instincts! Time is muscle! Call 911! And don’t be afraid to go back to the ER with new symptoms!

      Congrats on your cardiac rehab attendance and your 37 pound weight loss! You go, girl!

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    1. Thanks Pauline – and this is just a partial list of some of the more common heart attack signs! I’ve met women with truly bizarre symptoms that you’ll rarely find on any list (like one woman whose only symptom was that her upper lip went numb; another whose only symptom was a persistent dry cough!)

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  12. I had heart burn !! 42 years old & I coded in the ER! The paramedics who came to my house told me there was nothing wrong with me and my vitals are fine. I told them to take me anyway. If I had not been sitting in the waiting room at the emergency room I would’ve died at home, or at work that morning. The doctor performed CPR on me, worked for over 45 minutes… My heart was starting and stopping and starting and stopping and starting and stopping. He never gave up because “he saw signs of hope”

    After one stent and hypothermia-induced coma, days later I woke up. Confused, scared, and just unbelievable denial. I was black and blue from the CPR and had broken ribs.
    I was informed that I had had a heart attack, I still needed two more stents.

    It has been five years and with many medicine changes, career changes, lifestyle changes, I’m happy to report that I am a healthy 47 old mother of three boys living and loving life! I was diagnosed with coronary artery disease and familial hyperlipidemia. It was all genetics so know your family history, know the signs, I cannot stress enough! I haven’t decided what I’m going to do with my story because it’s rather bizarre to tell… I still have a hard time since I don’t remember anything!
    Peace,
    Stephanie T.
    Kansas City, Mo

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    1. Thanks so much for sharing your story here, Stephanie! Your story could have gone sideways at so many points (for example, had you not insisted to the paramedics to take you to the hospital, or if that doctor who performed CPR had not seen those “signs of hope”. Best of luck to you…

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