Women Are More Prone To Miss The Warning Signs Of Heart Disease

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%).

Racial Differences In Heart Attack Symptoms in Women

Dr. McSweeney and her colleagues didn't just discover that the symptoms of heart attack in women were quite different from the symptoms of heart attack in men. They also discovered that Black women, White women, and Hispanic women tended to have very different clusters of symptoms. The top 10 symptoms of acute heart attack, requiring immediate medical treatment, differ greatly by race.

In women of African-American heritage, the number one symptom of acute myocardial infarction, suggesting that it is a good idea to call the ambulance right away, is shortness of breath. The researchers found that 66% of African-American women who had heart attacks experienced shortness of breath first.

In Hispanic and White women, however, the number one symptom a heart attack is happening is chest or breast discomfort. "Chest" pain may be felt as "breast" pain by any woman who is having a heart attack or who is about to have a heart attack. 

The researchers also found that arm pain takes many different forms in women

Not just a crushing pain but also a twisting or burning pain can indicate a heart attack. And instead of pain there may be numbness or tingling. All indicate a heart attack is on its way.

Why do women's heart attack symptoms differ by race? Frankly, the researchers don't know. But being familiar with these symptoms may enable getting timely treatment for yourself or for a woman you know.

The top ten symptoms of heart attack in Black women are, in order:

1. Shortness of breath.
2. Any kind of discomfort of the chest or breast. This can be, but does not have to be, flu-like pain. Especially in Black women, may also mimic breast pain associated with hormonal changes.
3. Weakness.
4. Fatigue.
5. Dizziness.
6. Hot flashes.
7. Left arm symptoms (pain, burning, or numbness, in the left shoulder, left arm, or left hand).
8. Indigestion.
9. Cold sweat.
10. Nausea

The top ten symptoms of heart attack in White women are, in order:

1. Any kind of discomfort of the chest or breast. This can be, but does not have to be, flu-like pain.
2. Shortness of breath.
3. Feeling weak.
4. Unusual fatigue,.
5. Cold sweat.
6. Dizziness.
7. Left arm symptoms (pain, burning, or numbness, in the left shoulder, left arm, or left hand)
8. Feeling of heaviness in both arms.
9. Nausea.
10. Aching in the arms.

The top ten symptoms of heart attack in Hispanic women are, in order:

1. Any kind of discomfort of the chest or breast. This can be, but does not have to be, flu-like pain.
2. Shortness of breath.
3. Fatigue.
4. Feeling weak.
5. Pain in the high chest.
6. Left arm sensations.
7. Cold sweat.
8. Dizziness.
9. Pain between the shoulder blades.
10. Arms feeling heavy.

Very, very few women experience the classic signs of heart attack that are more often observed in men. (All of the symptoms listed here will also be experienced by a small minority of men having heart attacks.) Recognizing the symptoms of heart disease earlier leads to earlier treatment that can save lives and spare women months or years of disability.