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Men tend to discover they have heart disease by unmistakeable signs, like the often-reported "elephant sitting on my chest." The symptoms of heart disease and heart attack in women are much more subtle. Here 18 symptoms you may not have heard about.

Cardiologists and emergency room physicians have begun to recognize that men and women present different symptoms of heart disease, especially of heart attack. While symptoms of heart attack in men are usually anything but subtle, symptoms of advanced atherosclerosis and incipient heart attack in women are numerous, subtle, and often hard to detect. And symptoms of heart attack in differ by race.

Dr. Jean McSweeney of the College of Nursing at the University of Arkansas and 14 of her colleagues interviewed 1,270 women to find out what their most significant symptoms were just before having a heart attack. No more than 1 woman in 5 reported having any chest pain. In fact, the most frequent symptom that a heart attack was on its way was the one symptom that doctors are least likely to offer to treat.

Dr. McSweeney's research team found the most important symptoms of heart attack in women were:

  • Severe fatigue. Up to 77% of women, especially Black women, reported severe fatigue just before a heart attack.
  • Anxiety. Women often "just know" they are going to have a heart attack. At least 51% of Black and Hispanic women and about 37% of White women reported experiencing severe anxiety just before their heart attacks.
  • Frequent indigestion. About 40% of women experienced frequent, unexplaining tummy troubles (acid reflux, stomach pain, bloating, gas, burping, or belching) in the weeks leading up to a heart attack.
  • Racing heart. About 40% of women reported tachycardia (heart beating faster than 100 beats per minute even at rest) before they had heart attack.
  • Vision problems. Up to 37% of women reported problems with their vision, as if they needed glasses or they needed new glasses, in the weeks leading up to a heart attack.
  • Difficulty remembering. Up to 33% of women reported problems with short-term memory as heart problems became severe.
  • Loss of appetite. Up to 33% of women reported disinterest in food or cooking in the weeks leading up to their heart attacks.
  • Difficulty breathing. Up to 32% of women reported shortness of breath, even when they were not exercising, in the period before they suffered a myocardial infraction (MI).
  • Dry cough. Up to 32% of women in the study had a dry cough for several days or weeks before their admission to the hospital. Since dry cough is a common symptoms of the most commonly prescribed medication for high blood pressure, lisinopril, doctors may tend to ignore it in the women who are already being treated for their cardiovascular risk factors.
  • Numbness, tingling, or burning in the hands and arms. Also a symptom of uncontrolled diabetes, these symptoms were noted in 31% of women who suffered a heart attack.
  • Increased number of headaches. About 20% of women reported having more headaches just before they had a heart attack.
  • Increased severity of headaches. About 20% of women reported having worse headaches just before having a heart attack.

Chest pain was the most common pain symptom associated with heart attack--but no more than 20% of women experienced it.

Heart attack pain, the study showed, may occur in the legs (up to 15%), in both arms (up to 13%), just in the right arm (9%), or even in the jaws or teeth (up to 11%).

Many emergency medical technicians are taught that heart pain can only occur on the left side of the chest, which is wrong for both sexes, but especially for women. And symptoms of heart attack also differ greatly by race.

Continue reading after recommendations

  • Davis AM, Vinci LM, Okwuosa TM, Chase AR, Huang ES. Cardiovascular health disparities: a systematic review of health care interventions. Med Care Res Rev. 2007. 64(5 suppl):29S–100S.
  • McSweeney JC, O'Sullivan P, Cleves MA, Lefler LL, Cody M, Moser DK, Dunn K, Kovacs M, Crane PB, Ramer L, Messmer PR, Garvin BJ, Zhao W. Racial differences in women's prodromal and acute symptoms of myocardial infarction. Am J Crit Care. 2010 Jan. 19(1):63-73. doi: 10.4037/ajcc2010372.
  • Photo courtesy of rootology on Flickr: