Do You Know Which Symptoms Signal a Heart Attack in Women?

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Women having heart attacks are less likely than men to get immediate treatment and more likely to die in the hospital, says a groundbreaking new study that tracked more than 1.1 million patients.

Women are less likely to get immediate treatment to stop the heart attack in its tracks: clot-busting drugs, balloon procedures to open the arteries or bypass surgery, the study says. Partly because of such delays, 15% of female heart attack patients die in the hospital, compared with 10% of men. Delaying care can be fatal. "Time is muscle," says study author John Canto of the Watson Clinic and Lakeland Regional Medical Center in Florida. "And muscle is life."

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Most women know the symptoms of a heart attack -- squeezing chest pain, shortness of breath, nausea. But as it turns out, these symptoms are more typical for males. Female heart attacks can be quite different -- and it’s important for all women to learn the warning signs.

Rhonda Monroe's story is a cautionary tale. She was mystified when strong pain struck her left breast and left arm. Monroe, who was a 36-year-old mother of three, didn’t know it at the time, but she was having early symptoms of a heart attack. “I certainly wasn’t thinking about my heart because I was young and healthy and had been skinny,” she says.

As the pain moved into her shoulder and back, Monroe took pain relievers and showered for relief. But the next day, she was overwhelmed with nausea, sweating, vomiting, and chest pain. An ambulance rushed her to the emergency room.  

Her next hurdle: getting the doctors to believe her. “They didn’t take me seriously,” Monroe says. She didn’t fit the profile of a heart attack patient. The doctors told her she was too young, she was not overweight, and there was no family history of heart disease. 

Bedeviled by worsening pain and weakness and convinced she was dying, Monroe returned to the hospital several times over the days that followed, only to come home with no answers. “I was angry and frustrated,” the West Virginia resident says.

Monroe turned to her primary care doctor about her situation and went through more tests at the hospital. Finally, she got her diagnosis -- a week after the initial breast and arm pain. As Monroe recalls, a cardiologist who had previously dismissed her complaints made the diagnosis. “The doctor told me, ‘Well, it’s a good thing you’re persistent because you’re having a heart attack.’”

Heart experts say Monroe’s situation is all too common. Women who have “atypical” symptoms, such as arm or back pain or nausea, might not realize at first that they’re having a heart attack. Then when they do seek emergency care, doctors sometimes misdiagnose them.  

 heart attacks can be different than men’s. Learn the warning signs.

Typical” heart attack symptoms include chest pressure or squeezing or stabbing sensations in the center or left side of the chest, says Myung H. Park, MD, FACC, who is director of the Pulmonary Vascular Diseases Program at the University of Maryland Medical Center. “It’s very typical for people to make a fist when they’re describing their symptoms,” she says. “Some people describe it as feeling like a vise encasing their whole chest area.”

But in women, symptoms can be less typical. Although women can experience chest pain or discomfort, many don’t. In a 2003 Circulation study of female heart attack patients, scientists found that during an attack, 43% of the 515 women studied had no “acute chest pain, a ‘hallmark symptom in men.’”

The study noted some common female heart attack symptoms:

• shortness of breath (57.9%)

• weakness (54.8%)

• unusual fatigue (42.9%)

Women had other atypical heart attack symptoms, too: nausea, dizziness, lower chest discomfort, upper abdominal pressure or discomfort that feels like indigestion, and upper back pain.

Often, women are unaware that these symptoms can be a sign of a heart problem, and blame them on heartburn or indigestion, arthritis, or stress, experts say. If women become short of breath with little exertion, they tell themselves they are out of shape, overworked, or fatigued.

Pay attention to heart attack symptoms

Experts urge women to learn the various heart attack symptoms and to call 911 promptly at the appearance of these signs. 

Though most women feel indigestion once in a while, experiencing a cluster of unusual symptoms or a persistent sensation in the chest, back, or stomach never felt before is reason to seek emergency care. Park has seen too many patients wait too long. Because women have lots of competing demands -- jobs, families, and sometimes caregiving duties -- “taking care of themselves, even if they don’t feel well, usually doesn’t make it to the top of the list,” she says.

That can be dangerous, experts say. 

“The longer a woman waits before getting treatment to open the blocked blood vessel to the heart, the more damage is done to the heart muscle. If a large amount of the heart muscle is damaged, the woman will be at risk for heart failure,” says Teresa Caulin-Glaser, MD, co-author of The Woman’s Heart: An Owner’s Guide and director of preventive cardiology and research at McConnell Heart Health Center in Columbus, Ohio.

Assert yourself if you have heart attack symptoms

Unfortunately, doctors may also be unfamiliar with atypical symptoms and may overlook a woman’s heart attack, experts tell WebMD. In fact, according to theCirculation study, women have more unrecognized heart attacks than men and are more likely to be “mistakenly diagnosed and discharged from emergency departments.”

Be direct with doctors and other medical staff, Caulin-Glaser says: “Women arriving at the emergency room should state clearly that they think they are having a heart attack and need to be evaluated.”

At a minimum, an immediate evaluation should include being placed on oxygen, being given an aspirin, having blood drawn, having an electrocardiogram performed, and receiving a cardiac monitor within minutes of arrival, she says.

Being bold can save women’s lives, Caulin-Glaser adds. “If the triage nurse or emergency room physician does not take their concerns seriously and begin the immediate evaluation for a heart attack, then all women should tell the emergency room physician they want to be seen by a cardiologist.”

Shortly after Monroe’s heart attack was finally diagnosed, she underwent emergency quadruple bypass surgery. She reports that she didn’t know all the right questions to ask when she first felt symptoms, “but I definitely knew that something was wrong.” 

Now she urges other women who believe they might be having a heart attack to advocate for themselves. “Persist. No one knows your body the way you do,” Monroe says. “I really believe the only reason I’m alive today is that I wouldn’t give up, and I wouldn’t relent.”

Learn about your local heart attack resources

One of the most important ways you can advocate for yourself is doing research. “Take action before you ever have a heart attack,” Caulin-Glaser says.

“It’s important for women to do their homework regarding the hospitals in their neighborhoods. Find out which hospitals specialize in heart disease,” she says. Some questions for women to ask:

• Does the hospital have a cardiac catheterization lab that performs procedures such as angioplasties and stents?
• Is this “cath lab” available 24 hours, seven days a week?
• Is there a coronary bypass surgery program?
• Once a woman arrives in the emergency room with a heart attack, how quickly is she sent to the cath lab?
• Can doctors open a blocked blood vessel within the acceptable range of 90 minutes?
• Are all of the doctors in the emergency department board-certified in emergency medicine