by Carolyn Thomas ♥ @HeartSisters
“ I wasn’t short of breath, or dripping with sweat. I had chest pain WITHOUT left shoulder/jaw/arm symptoms or any other signs of illness. I attributed my chest pain to stress.”
This recent Twitter comment from a nurse about her own heart attack raises an important concern: have we done such a good job of warning women about freakishly weird non-chest pain heart attack symptoms that we no longer believe it’s really a heart attack unless we also have vague symptoms in a dozen other body parts? . .
So here’s a news flash: chest pain IS the most commonly reported heart attack symptom in BOTH men and women. Many women apparently do not know that, according to the shocking results of the American Heart Association’s National Awareness Survey released last fall. It found, among other disheartening findings, that only 52 per cent of women surveyed knew that chest pain is a cardiac symptom. I had to go have a wee lie-down after I first read that.
We also know that even when experiencing classic “Hollywood Heart Attack” cardiac symptoms, women are significantly less likely than our male counterparts to seek immediate help. In other words, we won’t do what we would almost certainly do if those symptoms were happening to somebody we care about. There’s even an entire field of research focused on WHY women so often choose to delay seeking treatment during a cardiac event compared to our male counterparts.
But when we deny the seriousness of our symptoms, women can end up:
- trying to minimize them
- waiting to see if they go away
- apologizing for making a fuss over nothing
- blaming symptoms on stress, muscle soreness, indigestion or any other less serious non-cardiac causes
- dying
Cardiologists like to say, “Time is muscle” when it comes to heart muscle at risk during a heart attack. The sooner you can restore blood flow to the heart muscle, the better your chance of reducing permanent heart muscle damage. If you experience the following heart attack symptoms – alone or in combination, and especially if they feel unusual for you – you can’t afford to waste that time:
1. Anxiety: Heart attack survivors often talk about having experienced an unusual “sense of impending doom” leading up to their cardiac event. Read this article on the difference between panic or anxiety episodes and cardiac symptoms. Sometimes symptoms are so frightening that about 40% of people with an anxiety or panic disorder end up going to Emergency at least once because they’re sure they’re having a heart attack – even when they are not.
2. Chest discomfort: notice the word here is ‘discomfort’, not necessarily ‘pain’. Pain in the chest is the classic symptom of the Hollywood Heart Attack, but not all heart attacks cause chest pain (at least 10% of women’s heart attacks, in fact, occur with absolutely no chest symptoms at all (1) – and that number in some studies is estimated as high as 42%(2). BUT not all chest pain means a heart attack. Women might not even use the word “pain” to describe their serious chest symptoms; instead, tightness, fullness, burning, heaviness or pressure. By the way, pain severity does not necessarily mean the most severe heart attacks. Relatively mild symptoms may reveal serious heart muscle damage, and vice versa.
3. Cough: persistent unexplained coughing or wheezing can be a cardiac symptom.
4. Dizziness: heart attacks or heart rhythm abnormalities can cause light-headedness or even loss of consciousness.
5. Fatigue: especially among women, unusual crushing fatigue can occur during a heart attack as well as in the days and weeks leading up to one. I’m not talking about the everyday exhaustion that seems to be “normal” for a busy woman, but the kind of new exhaustion – as one of my blog readers described, after being told her symptoms were likely due to depression and that she should consider taking anti-depressants – “Will these pills help me lift my laundry basket? Because I am no longer able to do that!” See also: How women can tell if they’re headed for a heart attack
6. Nausea or vomiting: it’s not uncommon for women to feel sick to their stomach or vomit during a heart attack.
7. Pain in other parts of the body: referred pain or discomfort can sometimes begin in the chest and spread to shoulders, arms, elbows, upper back, neck, jaw, teeth, throat or abdomen. Women may report an extreme sensation as if their bra is far too tight. But remember that cardiac symptoms might come and go, and then come back again – for days or even weeks. Pain can also radiate down either the left or right arm, jaw shoulder – or both, or in the back between the shoulder blades.
8. Rapid or irregular pulse: there’s usually nothing worrisome about an occasional skipped heartbeat, but a rapid or irregular pulse – especially when accompanied by weakness, dizziness, or shortness of breath – can be a cardiac symptom.
9. Shortness of breath: feeling winded at rest or with minimal exertion, “like you’ve just run a marathon when you haven’t even moved”, might be a significant cardiac symptom.
10. Sweating: breaking out in an unusual cold clammy sweat is a common sign of heart attack.
11. Swelling: often in the feet, ankles, legs, or abdomen, or as sudden weight gain (despite loss of appetite).
12. Weakness: in the days leading up to a heart attack as well as during one, some people experience severe, unexplained weakness.
Not every symptom listed here means heart attack, and not every heart attack shows up with every symptom. And as Cleveland Clinic cardiologist Dr. David Frid warns:
” The more cardiac risk factors you have, the higher the likelihood that a symptom means something is going on with your heart.
“People often don’t want to admit that they’re old enough or sick enough to have heart trouble. Putting off treatment for other medical problems might not be so bad, but a serious heart problem can mean sudden death. It’s better to go in and get it evaluated than to be dead.”
That’s 12 of the most common cardiac symptoms in women – but I’d also like to add one more for a possible Baker’s Dozen: “a pervasive sense of impending doom”. This awful feeling that something terrible is about to happen turns out to be remarkably common among women describing their cardiac symptoms. If this or any other symptom feels that unusual or “just not right” – get it checked out.
♥
Sources: Heart and Stroke Foundation, Mayo Clinic, American Heart Association, Cleveland Clinic
VERY VERY IMPORTANT NOTE: If you’re reading this because you’re currently experiencing troubling symptoms right now and are trying to figure out if they could be heart-related, remember this:
YOU KNOW YOUR BODY!
You know when something just does NOT feel right. Seek immediate medical help. Ask yourself what you’d do if exactly the same symptoms were happening to your mother, or your daughter, or a close friend! Then do the same thing for YOURSELF!
♥
(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, Journal of the American Medical Association. 2012;307(8):813-822. doi:10.1001/jama.2012.199.
Bicycle image: Angela Rose, Pixabay
Q: If you’ve had a heart attack, were any of your cardiac symptoms surprising to you?
NOTE FROM CAROLYN: Please remember that I am not a physician and cannot advise you. If you have significant symptoms that feel unusual for you, do not leave a comment here asking me about your symptoms. Seek a medical opinion from a doctor.
♥
NOTE #2 FROM CAROLYN: I wrote much more about identifying cardiac symptoms in Chapter 1 of my book, “A Woman’s Guide to Living with Heart Disease”. You can ask for it at your nearest library or local bookshop or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from my publisher, Johns Hopkins University Press (use the code HTWN to save 30% off the list price).
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See also:
How Does It Really Feel To Have a Heart Attack? Women Survivors Tell Their Stories
How Women Can Tell if They’re Headed for a Heart Attack
The Freakish Nature of Cardiac Pain (first of a three-part series on pain; the other two articles are linked at the bottom of this post)
Knowing and Going: Act Fast When Heart Attack Symptoms Strike
Too Embarrassed to Call 911 During a Heart Attack?
Is it a Heart Attack – or a Panic Attack?
The Myth of the “Hollywood Heart Attack” For Women
What is Causing my Chest Pain?
Skin in the Game: taking women’s cardiac misdiagnosis seriously
Heart Sisters 
I am going to admit that a few years back, I probably should have called 911 instead of pulling the car over, sitting for a while, and crying that it hurt so bad, then driving on to mom and dad’s and pretending nothing happened.
I was on my way home from work when I started getting a pain in my chest. It then hurt, starting at my fingers on my right hand up my arm, and into my jaw and teeth. To be honest, since it was my right arm, I assumed it wasn’t heart related.
I toughed it out, like I said. It did bother me enough, though, that I mentioned it to my Primary Care Physician when I saw him a week or so later.
He didn’t think it was my heart either, but did have me see a cardiologist for a work up. No one could find any cause. I think I figured out that is was a severe attack of acid reflux. Now, if I feel it coming on, which is does every once in a while, I get at drink of water and it calms it down so that it isn’t severe.
I now know what that feels like, but I was NOT smart to ignore it the first time it happened. I’m glad you have this blog to bring these things to light, and encourage us to stand up for our own health as much as we do for someone else that we love.
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Wow! I would say that a good general practice is, when you have pain that’s so bad you have to pull the car over to cry, it’s time to seek medical help. Thank goodness you decided to tell your doctor the next week!
I say this, of course, as a person who ignored chest pain so severe that I couldn’t walk more than five steps at a time – and instead of seeking help, I boarded a plane!
So much of medicine is also figuring out what the problem is NOT. And even if it turns out not to be heart-related, you’ll have some idea (we hope!) of treatment strategies to address whatever the problem is. And if your bad pain actually HAD been a heart attack, drinking a glass of water would not make it go away.
Thanks for your kind words – take care, stay safe. . . ♥
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Thanks. Yeah. That probably wasn’t my smartest move…not going to the ER. I’m glad it worked out, but if it happens again, I think I’ll make a different choice.
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You’re right! BUT that kind of response is so pervasively common in women that, as mentioned, researchers worldwide study our “treatment-seeking delay behaviour” – without so far coming up with any strategy to actually undo the historical effects of being raised to not make a fuss! That’s why I ask women what they’d do if those symptoms were happening to a loved one – it’s kind of a shake-up question that we all know the answer to. Just imagine, for example if it had been your passenger in the car that day instead of you, crying with pain! I know you wouldn’t have told her to hang on until her doctor’s appointment next week! 🙂
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You’re right. I wouldn’t have.
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I have had two heart attacks, 9 months apart, with zero cardiac risk. Physically fit athlete, no performance degradation while training, not diabetic, not overweight, low blood pressure. I had no pain, no dizziness, no pending sense of doom.
So, why did I go to the ER? My thanks goes to St. John’s ambulance elementary school training class. “Anything involving breathing or bleeding” needs medical attention. This simple statement stuck.
I slept in that morning, which is unusual for me, but I had just returned from high altitude training. So, I could logic that away. When I woke, my brain felt like it wasn’t firing fully on all cylinders – like you get when you are tired, but I didn’t feel tired. Figured I had just been too busy.
Had breakfast, then walked the dog. When I breathed in the cold air, I felt a very slight (aka ignorable) sting in my lungs and figured that I had frost nipped my lungs while training in the mountains. As I walked the dog, I couldn’t logic through the frost-nipped part because I hadn’t felt that symptom before returning home.
The most important symptom – the one that took me to the ER – was that my brain wasn’t “letting go” of its focus on my lungs. It’s a rudimentary sensation (bio feedback) that something isn’t right with your body. Its like when you are in labor and you focus on that area of your body – and nothing else. It’s that feeling when your shoes feel different and you discover you are wearing two different socks. In my case, my body felt different than the day before and my focus was on my lungs.
I went home and my husband continued to walk the dog. I was running across the garden taking down the Christmas lights while I waited. No problems, and the frost nip sensation stopped by holding my breath. So, whatever was happening… it involved breathing. We went to the ER to be checked out.
Enroute to the ER, I passed out in the car. My husband carried me in. The doctor thought I was a drug addict. He yelled at the nurse when she said there was something wrong with the EKG. I was sucking in oxygen, but not feeling like I was getting oxygen to my brain and lost the ability to talk. Then the cold sweat hit. I knew I was in shock but didn’t know why. I picked up 5 stents to two arteries that day.
Nine months later, I felt that same feeling in my lungs – easy to ignore – except that I was in bed in my house so there was no cold air. I called 911 to have the paramedic take his time explaining that I was having an anxiety attack. Initially he refused to transport me to the hospital but finally caved in. The on call cardiologist – with a known cardiac patient – was on the phone with my daughter during the paramedic debate and he refused to order transport. I laid on the cart at the hospital for about 20 minutes with the nursing staff talking about my monogrammed pjs and manicure before taking an EKG and calling for the STEMI. I picked up two additional stents that night to the third artery.
I have a lot of heart damage, partially resulting due to medical response delays. I am alive because of the cardiologists who saved my life and the nurses who were astute enough to know not to wait for the classic chest pains. If medical protocols demand chest pains and your heart attack has no chest pains… you are gonna lose heart tissue and possibly your life. And you might not be able to tell them when your oxygen gets so low that you are not able to speak.
My advice to others is to listen to your body. When you are hyper-focused on an area, it’s your brain telling you to pay attention… that something is happening to your life. If the paramedic doesn’t transport, don’t argue your point. This is the court of life. Take yourself to the ER. Don’t ignore Mother Nature.
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Hello Anne – thanks so much for sharing your dramatic cardiac story here! I like your astute observation that “my brain wasn’t letting go of its focus on my lungs…” We’d be wise to remember those words, and choose to pay attention to that inner voice. Unfortunately, some of us insist on arguing with that persistent voice (as I did after I was confidently misdiagnosed in mid-MI and then sent home from the ER – despite my Hollywood Heart attack symptoms including lots of central chest pain!)
There are several upsetting points in your story – where to start? – e.g. being accused of being a drug addict (which turns out to be a common cardiac misdiagnosis if you’re a woman who’s too young, too fit or too thin to fit their stereotype) or the paramedic refusing to transport you to the ER – and then (WORSE!) the on-call cardiologist refusing to order that transport FOR A WOMAN WHO IS A KNOWN HEART PATIENT! That is simply inexcusable negligence that I’d bet my next squirt of nitro spray would NOT happen had you been a male heart patient calling 911.
I’ve spoken to a number of paramedics and other first responders over the years who share the belief that, as one paramedic told me, “We’d rather come to your aid even if it’s a false alarm, than NOT be there if it turns out to be a true emergency.” But cardiac gender bias is alive and well for women, sadly, as many studies continue to report. One of the most glaring examples, in my opinion, was a study that found when a female heart patient is in the ‘back of the bus’, ambulance drivers are significantly less likely to turn on their flashing lights and sirens.
I often tell my “Heart-Smart Women” audiences (and my readers here) that if you’re a woman in mid-heart attack who presents to Emergency with NO chest pain, you can pretty well kiss a cardiac diagnosis goodbye. This bias has also been reported by Harvard researcher Dr. Catherine Kreatsoulas in her studies on how women having a heart attack communicate to Emergency staff; more on her unique perspectives here.
Take care, Anne – and stay safe. . . ♥
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And another thought… you can have a “stellar” cardiac stress test result on a treadmill and still have a heart attack, even have one prior to the test that you didn’t realize at the time.
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Hi Holly – this IS a bizarre reality of cardiac diagnostic tests. My understanding is that it’s the soft vulnerable plaque (common among female patients with coronary artery disease) that can rupture and cause a dangerous blockage of a coronary artery, which can lead to a heart attack. So much depends on the stability of the ‘fibrous cap’ that covers this central core of soft vulnerable plaque. When the cap becomes unstable, it leaves the plaque prone to rupturing.
So yes – we can have a “normal” treadmill test one day (because the fibrous cap is still securing the plaque inside the coronary artery) but this can rupture the next day, or the next hour. Those ‘surprise” heart attacks that we don’t realize are called “silent heart attacks” – later diagnostic tests can reveal heart damage that may not have been felt at the time, or blamed on other non-cardiac causes (like, having the flu, etc.). Again, NOT all heart attacks look like that stereotypical old white guy out on the golf course, clutching his chest in agony before falling down.
Take care, stay safe. . . ♥
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