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Younger women are at greater risk for fatal heart attacks than younger men. Part of the reason is that women don’t have symptoms doctors usually associate with ischemic heart disease

Cardiologists at Yale University interviewed 30 women between the ages of 30 and 55 who had had heart attacks. Every woman interviewed said that at first she had ignored symptoms because they didn’t have the usual risk factors for coronary artery disease, and they did not realize their symptoms were those of heart attack.

American comedienne and talk show host Rosie O’Donnell had a heart attack in 2012 at the age of 50. Near death when she was brought to the hospital, she did not seek medical treatment for 24 hours because she did not realize she was having a heart attack.

Every year, 15 thousand American women aged 50 or younger die of heart attacks. In the hospital, these younger women have twice the risk of men of dying of an acute myocardial infarction. Part of the reason is that the symptoms of heart attack in most women are not as dramatic as those in most men.

No Clutching at the Chest and Falling to the Ground

The stereotypical heart attack in men is announced by the sudden onset of intense chest pain and a loss of muscle strength, often with a physical collapse. The pain radiates from the chest to the neck and left arm, and there can be intense perspiration.

Women’s heart attack symptoms can be quite different. Women may have signs of heart attack for days or even weeks before they finally seek medical treatment. A woman can have intense chest pain with a heart attack, but she may have no chest pain at all. The pain may radiate to the left leg rather than the left arm, or to the right arm instead of the left arm, or to both legs and both arms, there can be headache instead of neck pain, and flu-like symptoms such as shortness of breath, nausea, and vomiting. Some women don’t have any symptoms at all.

Doctors Recommend Seeking Treatment Within Five Minutes of Onset of Symptoms

Medical experts, of course, recommend immediate treatment of symptoms. The greatest opportunities for preventing permanent damage to the heart occur in the first hour of a heart attack, not the first week or the first month. Women are urged to go to the emergency room even with “odd” symptoms that don’t match the usual understanding of a heart attack. It’s clearly better to be safe than sorry.

However, even when women present themselves to the emergency room with a full-fledged heart attack, the cardiologist may not find what would be expected in men.  The tried and true “clog in the pipes” model of coronary artery disease may not apply to most women. Even when women come in with serious pain and abnormal EKG’s that lead doctors to do diagnosis with enzymes, ultrasound, and catheterization, the coronary artery dysfunction may be something entirely different from what the doctor usually looks for.

  • Jespersen L, Hvelplund A, Abildstrøm SZ, et al. Stable angina pectoris with no obstructive coronary artery disease is associated with increased risks of major adverse cardiovascular events. Eur Heart J 2012. 33:734–44.
  • Likoff W, Segal BL, Kasparian H. Paradox of normal selective coronary arteriograms in patients considered to have unmistakable coronary heart disease. N Engl J Med 1967.276:1063–6.
  • Photo courtesy of katmere: www.flickr.com/photos/katmere/4600121354/
  • Photo courtesy of sentxd: www.flickr.com/photos/sentxd/5799138195/

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