“ 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
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 heart muscle damage. If you experience the following 12 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 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: 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.”
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).
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)