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Heart Attack Symptoms in Women May Not Include Chest Pain

Heart attack and women

Heart disease remains the number one killer among both men and women in the United States; however, women are especially at risk of death because their symptoms are often quite different than a man’s so they may not even realize they are having a heart attack. This “atypical presentation” can lead to a delay in medical treatment.

The “hallmark” symptom of a heart attack is often thought of as having chest discomfort or pain – an uncomfortable pressure, squeezing, fullness or pain in the center of the chest that lasts for more than a few minutes or goes away and comes back. But women, especially younger women, are more likely to present without chest pain finds a study encompassing more than a million heart attack patients. This situation makes women more likely to die from a heart attack than men of the same age.

John Canto MD MSPH of the Watson Clinic in Lakeland, Florida, and colleagues analyzed medical records in a national database which included about 1.1 million people from almost 2,000 US hospitals between 1994 and 2006. The team found that 42% of female patients presented to the hospital without chest pain or discomfort as their primary symptom. Women under 45 were 30% more likely than men in their age group to present without pain.

Common symptoms included unexplained shortness of breath, pain in the upper body (jaw, neck, arms, back, or stomach), nausea/vomiting, lightheadedness or fainting, or breaking out in a cold sweat.

Unfortunately, younger women without chest pain were almost 20% more likely to die from their heart attack than their male counterparts.

Cam Patterson, chief of cardiology at the University of North Carolina-Chapel Hill who was not involved in the study, says he was shocked by the findings. “This study makes me worried that we still don't get it. We are doing a miserable job of educating women."

Treatment for heart attack is most effective when started within 1 hour of the beginning of the symptoms, so acting fast is critical.
With that in mind, Dr. Travis Stork, an ER physician and co-host of the popular TV show “The Doctors,” explains four common heart attack symptoms other than chest pain.

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1. Indigestion
Indigestion – an everyday occurrence for some folks – can indicate a heart attack is approaching, especially in women, according to research by the National Institutes of Health. With this unpredictable symptom, look for it to be combined with jaw, chest or back pain, anxiety or excessive sweating.

2. Pain and discomfort in the stomach, neck or jaw
Dr. Stork says if it is not related to any physical injury and the symptoms don’t add up, that’s when caregivers need to be concerned. Look for a case where an individual is starting to have what physicians call “referred pain” from their jaw to their arm and there’s no good explanation. On top of that, they may complain of generalized weakness or lack of energy.

3. Headaches
Researchers say migraine headaches can be a warning sign of a heart attack, and women in particular who experience migraine with aura (a migraine accompanied by sensory symptoms, like flashes of light, blind spots or tingling in your hand or face) can have double the risk of heart attacks.

4. Fatigue or Generalized Weakness
Dr. Stork says that when it comes to fatigue, a heart attack tends to be something different than you’ve experienced before. The words “It just doesn’t feel right” or “I haven’t felt this way before” should be warning signs to watch for. Look for fatigue or generalized weakness associated with other subtle symptoms like shortness of breath. Feeling stressed out, having a headache and being tired might be things that a person experiences on a daily basis, explains Dr. Stork. “But if you’re feeling fatigue and maybe a little more short of breath than normal, and if something just doesn’t feel right, don’t ignore those symptoms.”

Overall, Dr. Stork it’s not your job as either the patient or the caregiver to diagnose a heart attack in progress. More importantly, ask “Is something potentially wrong here to the point where we need to seek further medical attention,” he says.

JAMA Press Release: Younger Women Have Symptoms Other Than Chest Pain and An Increased Risk of Dying After Heart Attack. February 21 2012

Additional Resources:
Silent Killers: 5 Overlooked Heart Attack Symptoms Care2.com.
The National Coalition for Women with Heart Disease: Heart Smart 101

Photo Credit: Wikimedia Commons