NOTE FROM CAROLYN: I wrote much more about cardiac symptoms and how to address them in my book A Woman’s Guide to Living with Heart Disease (Johns Hopkins University Press, 2017). You can ask for this book at your local library or favourite bookshop, or order it online (paperback, hardcover or e-book) at Amazon. If you order it directly from Johns Hopkins University Press (use their code HTWN), you will save 30% off the list price.
Before I was misdiagnosed with acid reflux in mid-heart attack and sent home from the E.R., I knew basically nothing about what a woman’s heart attack can feel like.
And because of my mistaken heart attack stereotypes (old fat guy out on the golf course clutching his chest in agony, falling down unconscious), I believed the Emergency physician who confidently pronounced,“It is NOT your heart!” But five months after surviving that heart attack, I was shocked to learn this comprehensive list of women’s most common cardiac symptoms during my first trip to Mayo Clinic:
Warning signs of a heart attack:
- ♥ an abrupt change in how you feel
- ♥ pain, discomfort, pressure, heaviness, burning, tightness, ache or fullness in the chest, left or right arms*, upper back, shoulder, neck, throat, jaw or abdomen (generally, anyplace between neck and navel). These used to be called atypical cardiac symptoms when they happened to women. But women make up half of the population, so how can our symptoms be called “atypical”? Chest pain is the most common heart attack sign for both men AND women; this may be central, or felt “armpit to armpit”; in at least 10% of women, no chest symptoms at all are present during a heart attack. (1) UPDATE, OCTOBER 20, 2021: Read about the first ever Guidelines for Evaluation and Diagnosis of Chest Pain issued jointly by the American College of Cardiology and the American Heart Association.
SPEAKING OF CHEST PAIN. . . Study results on the absence of chest pain in women vary widely, ranging from about 8-42% depending on which study you read. For example, as Florida cardiologist and researcher Dr. John Canto explained to me via email (December 3, 2016):
“Chest discomfort is the hallmark symptom for both women and women during myocardial infarction (MI, or heart attack). But absence of chest pain is more commonly seen in women than men. On average, in our 2012 national study (1.1 million MI patients, 465,000 of them female), 38% of women with STEMI did not have this hallmark chest pain symptom on presentation.(2) This is because (older) age is a major contributing factor to MI presentation without chest discomfort and more women who present with MI are older than men, on average by almost a decade.”
But cardiologist Dr. Sharonne Hayes, founder of the Mayo Women’s Heart Clinic, told me that she now prefers to:
“. . .focus less on symptom DIFFERENCES (which multiple studies suggest are few and can’t be relied upon for diagnosis) and more on symptom RECOGNITION by patients and physicians, which continues to contribute to disparities in outcomes.”
- ♥ weakness, fainting, light-headedness, or extreme/unusual fatigue
- ♥ shortness of breath, difficulty breathing
- ♥ restlessness, insomnia or anxiety
- ♥ bluish colour or numbness in lips, hands or feet
- ♥ nausea, vomiting
- ♥ clammy sweats (or sweating that’s out of proportion to your level of exertion or environment
- ♥ persistent dry barking cough
- ♥ a sense of impending doom
Not all of these signs occur in every heart attack. Pay attention if these signs come on suddenly or feel unusual for you. YOU KNOW YOUR BODY!! You know if something is “just not right”.
During my own ‘widowmaker’ heart attack, I was able to walk, talk, think, drive my car, go to work, and walk into the Emergency Department (where despite my textbook symptoms (central chest pain, nausea sweating and pain down my left arm), I was promptly misdiagnosed with acid reflux and sent home). More on this story here.
Sometimes heart attack symptoms go away – and then return. When they go away, it’s tempting to just shrug them off and go on with your day. If they come back, seek help!
They usually come on with exertion, but may also appear when you’re at rest.
Women typically wait longer than men to call for help. Find out why. Don’t do this!
Ask yourself what you would do if these exact symptoms were happening to your daughter or your Mum or your sister. Then do that for yourself.
LISTEN to your body. DON’T IGNORE symptoms. GET HELP fast.
Women often experience other ‘non-classic’ symptoms that are not immediately associated with heart concerns – symptoms that can appear weeks before the actual cardiac event. An Oregon study found that up to 95% of women experience early warning signals (called prodromal symptoms) weeks or even months leading up to their cardiac event. Researchers reported that female heart attack survivors often reported these warning symptoms before the attack:
- 70% reported severe, unexplained fatigue
- 48% had sleep disturbances
- Almost half had shortness of breath, indigestion and anxiety
- Almost half had no chest symptoms
and during the attack:
- 50% had shortness of breath and weakness
- 50% had extreme fatigue, cold sweats and dizziness
Despite these findings, the Heart & Stroke Foundation notes that chest pain is still the most common warning sign in both sexes.
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 being a bother. Do not self-diagnose by saying something like: “It’s probably 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 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. Ambulance paramedics can start an EKG, administer life-saving meds, and call ahead to the Emergency Department to minimize dangerous delays.
-I recommend the medical website Up To Date which has a basic patient-friendly section all about chest pain, with some useful tips on telling the difference between chest pain that is likely heart-related, and chest pain that is NOT.
-Watch this 22-minute documentary called “A Typical Heart“, a remarkable Canadian film about the deadly disparity between male and female heart disease, as experienced through the lens of healthcare professionals, researchers, patients, and their families (Disclosure: I was one of the eight Canadian heart patients interviewed).
–Make the Call – Don’t Miss a Beat is a women’s heart attack symptom awareness campaign
Learn more about signs and symptoms of women’s heart attacks from The Heart Truth, the Heart & Stroke Foundation’s campaign to educate women about heart disease
Get help translating confusing heart disease terminology, phrases and jargon
If you or somebody you know has been diagnosed with heart disease, you can find support from other heart patients in the comfort of your own home by joining the free 24/7 online support community hosted by WomenHeart: The National Coalition For Women With Heart Disease.
(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.
Updated August 10, 2022