Heart Attacks in Women Look Different

Between the ages of 45 and 64, one in nine women develop symptoms of some form of cardiovascular disease. After the age of 65, this ratio increases to one in three women according to the National Center of Health Statistics. Most people are aware of the classic symptoms of a heart attack – pressure in the center of the chest that sometimes travels up the jaw or down the arm. In the stable form of cardiac chest pain, chest tightness can be aggravated by exertion or emotional stress and is relieved by rest or nitroglycerin.

In the unstable form of a heart attack, the symptoms can be experienced even at rest. This cardiac chest pain is called angina. While it’s extremely useful to evaluate a patient’s symptoms, it’s a definition created using data from predominantly male patients. Over time, we have found that women may experience heart attacks differently. This is also true for people with diabetes.

Although studies show that women often present with heart attacks with similar complaints of chest pain when compared to men, many women experience different symptoms such as pain in an unusual pattern, shortness of breath, abdominal pain or nausea.

Know your risk

Traditional risk factors for heart attack and stroke that women and men share in common include advanced age, a family history of coronary artery disease, high blood pressure, obesity, diabetes, tobacco use, and high cholesterol.  However, there are several cardiovascular risk factors that are unique to women, the most common of which is being post-menopausal. While women who have not experienced menopause are generally at lower risk for heart attack and stroke, post-menopausal women are at higher risk for both these conditions. What’s more, women who have gone through chemotherapy treatment, targeted therapies or some forms of radiation may also be at greater risk of heart-related problems.

Other risk factors unique to women include a past history of diabetes or high blood pressure that previously developed during pregnancy or having autoimmune disease, which women are more likely to develop than men. Having an autoimmune disease, such as Rheumatoid Arthritis or Lupus, can put someone at higher risk of heart attack and stroke, especially if the autoimmune disease is left untreated. These conditions cause inflammation in the body that can affect cardiovascular health.

Protect your heart  

Eating healthy, not smoking or using tobacco products of any kind, and maintaining regular physical activity are the keys to good cardiovascular health for everyone. Maintaining a healthy weight – particularly avoiding visceral fat, or fat that develops around the waist or abdomen, is especially important. This type of fat has been shown to be more harmful to your overall health.  

Women using hormone replacement therapy, especially those who continue to use it many years after the onset of menopause, who have other cardiac risk factors should be cautious and should discuss the risks of continued use with the doctor who prescribed this medication. All patients and women in particular should be sure their physician is identifying and treating any risk factors they have for cardiovascular disease. It’s important to pay close attention to your own intuition when something doesn’t feel right and choose a provider with whom you feel comfortable speaking about your symptoms or concerns. Lastly, your primary care provider should pursue a thorough workup to exclude a cardiac cause of symptoms or refer you to a cardiologist.

Despite the fact that we know there are differences in the cardiac risk factors between men and women, and subtle differences between clinical presentation and diagnostic strategies for cardiovascular disease, there is still a higher proportion of women who have a missed or delayed diagnosis of heart attacks. While to some extent this has to do with the differences in the ways women present with cardiac symptoms, bias may specifically come into play when assumptions are made that women are somehow “overreacting” to symptoms.

In my own practice, I routinely see women who report concerning symptoms with underlying cardiovascular issues despite a “normal” initial cardiac workup. Sometimes performing a higher level of testing using advanced technology helps unearth significant cardiac issues that require drastic changes in medical management and could have led to dire consequences if the symptoms were left untreated.

I am fortunate to be part of an outstanding team of cardiologists at The Chattanooga Heart Institute who truly listen and use emerging technology to treat all patients, including those who present with atypical symptoms.

For more information, visit chattanoogaheart.com or call (423) 697-2000 to schedule an appointment.