Before I was misdiagnosed with acid reflux and sent home from the Emergency Department, the heart attack symptoms I was experiencing had seemed pretty dramatic during that eventful early morning walk. They were, in fact, what all physicians (and Dr. Google) would consider to be typical heart attack signs.
My most debilitating symptom at the time was the chest pain that doctors know as angina pectoris (a Latin name that translates gruesomely as “strangulation of the chest”). In my case, it felt like a cross between a Mack truck parked on my chest and a burning searing pain going up into my throat. I also felt like I was going to vomit, I was sweating profusely, and I had pain radiating down my left arm. (None of those textbook symptoms, by the way, helped to convince the Emergency physician that I was, in fact, having a heart attack. Read more about misdiagnosis of women’s heart disease in this Heart and Stroke Foundation report here).
Those textbook “Hollywood Heart Attack” heart attack symptoms in both men and women can typically include:
- chest pain or discomfort
- crushing fatigue
- shortness of breath
Particularly in women, cardiac symptoms that are called “atypical” may also be reported. But, as paramedic/women’s heart health researcher/documentary filmmaker Cristina d’Allessandro asks in the film “A Typical Heart”:
“Why do we call women’s symptoms ‘atypical’ when women make up more than half the population?”
Here are some not-quite-textbook cardiac symptoms that you should know:
- an abrupt change in how your body feels*
- chest pain, which may be central or be felt armpit to armpit (and may not even be described by the word “pain”) but in at least 10 percent of women(1) – and that may be as high as 40 percent(2) depending on the clinical study – no chest symptoms at all are present during a heart attack
- unusual pain, discomfort, pressure, heaviness, burning, tightness, or fullness in the left or right arm, upper back, shoulder, neck, throat, jaw, or abdomen
- weakness, fainting, light-headedness, or extreme/unusual fatigue
- shortness of breath and/or difficulty breathing
- restlessness, insomnia, or anxiety
- a bluish color or numbness in lips, hands, or feet
- nausea or vomiting
- clammy sweats (or sweating that’s out of proportion to your environment or your level of exertion)
- persistent dry, barking cough
- a sense of impending doom
During a heart attack, our heart muscle cells begin to run out of oxygen because something is preventing the oxygenated blood flowing through our coronary arteries from feeding that muscle.
A heart attack may also cause a sensation of pain or discomfort to travel from the heart to the spinal cord, where many nerves merge onto the same nerve pathway. Your arm may be perfectly fine, for example, but your brain thinks that part of your pain is in the arm (or in the jaw, shoulder, elbow, neck, or upper back) screaming out for help.
That’s what referred pain is. It happens when pain is located away from or adjacent to the specific organ involved – such as in a person’s jaw or shoulder, but not necessarily anywhere near the chest.
Not all of these signs occur during every cardiac event. Some female survivors report that their symptoms came on suddenly and simply felt unusual – not alarming.
Sometimes the most extreme symptoms don’t necessarily imply the worst heart muscle damage. Symptoms can also go away and then return over time.
Stable symptoms typically become worse with exertion but go away with rest. If symptoms come on when you’re at rest, they’re considered to be unstable – and that could mean a serious emergency for which you need immediate medical care.
LISTEN to your body. DON’T IGNORE symptoms. GET HELP fast.
What to do if you’re having these symptoms:
- Immediately call 911 and say: “I think I’m having a heart attack!” Do not apologize for bothering them. Do not minimize your symptoms. Do not self-diagnose by saying something like: “It’s probably nothing, just a pulled muscle, indigestion, stress…” etc.
- Chew one full-strength uncoated aspirin tablet (with water if you like) while you’re waiting for the ambulance. .NOTE: Some people should NOT take aspirin if they’re on certain drugs, or are allergic to aspirin, or have a non-allergic sensitivity to aspirin. Check with your doctor, and if you’re one of these people, skip this step.
- Unless absolutely unavoidable, do not drive yourself to the hospital – and do not ask a friend or family member to drive you there.
(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 20–26.
(2) J. Canto et al, “Association of age and sex with myocardial infarction symptom presentation and in-hospital mortality,” JAMA. 2012 Feb 22;307(8):813-22.
* An abrupt change in how you feel is probably the most important message your heart can send you. If symptoms “just don’t feel right”, if they feel unusual for you, if you have never experienced anything like them before, do not hesitate to seek help.
Read more about heart attack symptoms in my new book, A Woman’s Guide to Living with Heart Disease (Johns Hopkins University Press, 2017). This post is a brief excerpt from Chapter 1 of this book, which is already in its second printing! Thank you, readers!
NOTE FROM CAROLYN: If you are experiencing these or other alarming symptoms described here, see your doctor. Please DO NOT leave a comment here asking me what you should do. I am not a physician and cannot tell you. This blog is not a substitute for professional medical advice.
Q: Heart patients: would you describe your own first heart attack symptoms as typical or atypical?
-Watch this 22-minute documentary called “A Typical Heart“, a remarkable Canadian film about the deadly disparity between male and female heart disease, through the lens of healthcare professionals, researchers, patients, and their families (Disclaimer: I was one of the eight Canadian heart patients interviewed).