Am I having a heart attack?

by Carolyn Thomas  @HeartSisters

Warning signs for a heart attack:

  • an abrupt change in how you feel
  • atypical pain, discomfort, pressure, heaviness, burning, tightness or fullness in the chest, left or right arms, upper back, shoulder, neck, throat, jaw or abdomen. Symptoms may come on and then go away, and come back again. Chest pain may be central, or felt “armpit to armpit”; in about 8-10% of women, no chest symptoms at all are present during a heart attack. (1)  Study results on the absence of chest pain in women vary widely, from 8-42%. For example, as Florida cardiologist Dr. John Canto explained to me (December 3, 2016): “Chest discomfort is the hallmark symptom for both women and women during myocardial infarction (MI, or heart attack).  But when absent, it 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 did not have this hallmark 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. ”  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. Sometimes they go away and then return. They usually come on with exertion, but may also appear when you’re at rest. Women typically wait longer than men to call for helpFind out why.

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LISTEN to your body.  DON’T IGNORE symptoms.  GET HELP fast.

Women often experience other ‘non-classic’ symptoms that are not typically associated with heart attacks – symptoms that can appear weeks before the actual cardiac event. An Oregon study found that up to 95% of women experience early warning signals (prodromal symptoms) weeks or even months leading up to their cardiac event. Researchers reported that female heart attack survivors often reported these symptoms weeks before their attacks:

  • 70% reported severe, unexplained fatigue
  • 48%  had sleep disturbances
  • Almost half had shortness of breath, indigestion and anxiety
  • Almost half had no chest symptoms

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, affecting about 60% of all heart attack patients.

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 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 are allergic to aspirin, or have a non-allergic sensitivity to aspirin. 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.

See also:

  • 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

If you or somebody you know has been diagnosed with heart disease, you can join the free online support group hosted by WomenHeart: The National Coalition For Women With Heart Disease.

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(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 2026.
(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.

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Updated December 2, 2016

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