Menopause Mondays: Recognizing Female Heart Attack Symptoms Can Save Your Life - Ellen Dolgen

Menopause Mondays: Recognizing Female Heart Attack Symptoms Can Save Your Life

Elephants like to sit on men’s chest. Women’s, not so much. During heart attacks, women often suffer from symptoms that are far different than the stereotypical chest pains that men experience. And recognizing those signs—and getting to an emergency room ASAP—could save your life.

“Delay in treatment can often result in permanent damage to the heart and lead to heart failure, lethal arrhythmias, and death. Early recognition leads to early treatment,” says Laxmi Mehta, MD, Clinical Director of the Women’s Cardiovascular Health Program at The Ohio State University Medical Center.

Women are 52 percent more likely than men to have at least 15-minute delays in treatment for heart-attack-related 911 calls, according to research published in Circulation: Cardiovascular Quality and Outcomes. 435,000 American women have heart attacks each year, and while 42 percent of women who have them die within one year, only 24 percent of men die within one year of suffering a heart attack, according to the Women’s Heart Foundation.

“Most of the available data and research is on men. Only over the last one to two decades there has been a drive to mandate women be included in research studies. From this we are slowly starting to understand more about the female heart,” Mehta says. While the differences in men’s and women’s “atypical” heart attack symptoms are not completely understood, differences in the nerves that feed the heart as well as women’s higher pain threshold (handy when it comes to childbirth) could be contributing to confusion in identifying symptoms, according to Mehta.

What’s more, the most common heart attack symptoms in women can be confused with everything from stress to a backache. However, women also know when something just doesn’t feel right, says Malissa J. Wood, MD, co-director of the Corrigan Women’s Heart Health Program at the Massachusetts General Hospital Heart Center. “Women have intuition and should use it. It can save their lives,” she says.

Estrogen promotes cardiovascular health by keeping blood vessels flexible so that they can relax and expand to accommodate blood flow. During menopause, however, estrogen levels drop, raising women’s risk of heart disease (and giving us oh-so-joyful hot flashes!). The level of fats in the bloodstream increases while the walls of the blood vessels collect an increased level of plaque. What’s more, the evil weight gain that goes hand-in-hand with menopause also increases the risk of heart disease, according to Northwestern Memorial Hospital.

I touched base with menopause specialist Josh Trutt, MD, a healthy aging expert from PhysioAge Medical Group in New York City, to help understand the latest info on estrogen and heart disease. According to Trutt, the more time that goes by without estrogen in the body, the more plaque that builds up in a woman’s arteries. Taking estrogen orally actually causes plaques to reorganize and become stable, which is a good thing—unless you have big piles of unstable plaque in your arteries. Any effort to “move” large unstable plaques may cause them to rupture, leading to a heart attack or stroke, he says.

That’s why early studies (like the Women’s Health Initiative) showed that giving estrogen pills to obese women with high blood pressure who were already ten years past their “change,” was a bad idea: Those women had large, unstable plaques, and in that first year of taking oral estrogen, some of those plaques “tipped over” as their bodies tried to stabilize them, Trutt says. They therefore had an increased risk of heart attack and stroke during that first year after starting hormone replacement therapy. This is why women over the age of 60 and women with high blood pressure or obesity should never use oral estrogen, he says. (They can still use creams, patches, or pellets.)

Younger, healthier women (less than ten years past the onset of menopause) have much smaller plaques, and in those women, oral estrogen has been shown to help them reorganize and stabilize those plaques and reduce the risk of heart disease, Trutt says. Plus, results from the recent Kronos Early Estrogen Prevention Study, or KEEPS, showed that hormone therapy does not increase blood pressure or hardening of the arteries, and has a neutral or even positive effect on cholesterol levels in menopausal women.

If you have one or more of these symptoms and believe you may be experiencing a heart attack, seek help immediately. “Better safe than sorry” is cliché for a reason: It’s true.

Upper Body Discomfort
Heart attacks strike more than under your bra cups. Many women also experience neck, jaw, back, and shoulder pain during heart attacks, since the nerves that supply these areas also supply the heart, Wood says.

Fatigue and Weakness
When was the last time you didn’t feel exhausted? While fatigue can be a symptom of life, it can also be caused by decreased blood flow to the brain, she says. If your heart doesn’t pump as it should, oxygen- and glycogen-rich blood, which your body needs for energy, won’t fuel your organs.


Sleep Disturbance
During sleep apnea, the upper airway becomes completely or partially blocked, interrupting breathing and decreasing the amount of blood pumped to the heart, increasing your chance of having a heart attack or dying by 30 percent over a period of four to five years, according to research from Yale University. If you wake up and still can’t catch your breath, you may be suffering from a heart attack.

Nausea, Vomiting, and Feelings of Indigestion
“Similar nerves supply the stomach and the heart, while some areas of the heart, when injured,can cause nausea,” she says. Also, as acid reflux causes pain right behind the heart, heart attacks in women can feel like a simple case of eating too much take-out.

Shortness of Breath
Getting winded during an exercise class is one thing. Getting winded while watching TV is another. A heart attack can decrease the pumping function of the heart, while increasing blood pressure in the heart and lungs, says Wood. The result: difficulty breathing.

Feelings of Anxiety
A rapid heart beat and sweating can easily be confused for your run-of-the-mill anxiety, but they can also be signs of a heart attack, she says. If you feel these sensations when you are otherwise calm or while participating in a calming activity, your nerves may be reacting to your heart’s overexertion.

Suffering in silence is OUT! Reaching out is IN! If you experience any of these symptoms, don’t shrug them off! As women, it’s easy for us to get so wrapped up in taking care of everyone else’s needs (think: science fair projects and seemingly endless mountains of laundry) that taking care of ourselves with things like doctors’ visits (and don’t forget mani-pedis!) become optional addendums. But remember: You aren’t truly able to care for anyone else until you first care for yourself. So listen to your body. It’s telling you something!


20 thoughts on “Menopause Mondays: Recognizing Female Heart Attack Symptoms Can Save Your Life”

  1. Thank you for the clear explanation of why the early research results on ERT and heart disease were so different than the advice we hear today. There is so much conflicting advice on ERT. I keep hoping it’ll all be settled before I’m there, but that seems unlikely.

    1. THANK YOU Ginger. There is so much research and so many studies out every day that I feel I’m spending all my days just trying to find the most useful information to deliver to you and other women out there. Whenever you need any advice, give me a shout out on Facebook or Twitter and I’ll do my best to get you the information you need – and give it to you in lay-womans terms! Hugs, Ellen

  2. This problem happened to Rosie O. in the last year, and she’s lucky to be alive. She didn’t recognize the subtle signs–fatigue and arm pain. Her arm pain was bilateral. And she had nausea. She’s near my age, so I took the news story to heart (pardon the pun). The big, drama heart attacks usually don’t apply to women. Good info.

  3. Helene Cohen Bludman

    This is so important to know, Ellen. Thanks so much for bringing this to the forefront. I might just thumb tack this to my bulletin board.

  4. Ellen, I can’t thank you enough for sharing your vast knowledge on this subject. I have heart disease and stroke in my family, and don’t exercise as I should (due to MS; still no excuse) and am scared to death (bad pun) of having heart issues. This information is extremely helpful. Thanks for providing it.

  5. I first learned about this a year or two ago when I attended a TedWomen conference and it was discussed. The difficult part is that even knowing that the symptoms are different than men’s and knowing what they are, you still don’t really know because our symptoms could really be anything. Men’s symptoms shout heart attack! Women’s whisper something is possibly wrong but maybe not.

  6. Such an important issue; I profiled a woman who had a heart attack at the age of 40 and was still walking and talking and thinking she was fine through the dr.’s office AND the ER – it’s a good thing her office doc caught it (when what she thought she had was the flu).

  7. What kind test should I ask for from my Doctor? I’ve been having some of these symptoms and they do an EKG and tell me I’m fine. It’s been a while since I’ve been in to see the Doctor because I think they think I’m crazy. I’m 53 years old and I’ve always been very healthy. I’ve never had weight issues. I am however experiencing several of these symptoms. HELP! Thank you.

  8. I have been having chest pains and my left arm in some pain for over a month. I have had a EKG and a catheterization. The for say there is nothing wrong with my heart. These attacks come out of nowehere. Last from 2-5 mins. I feel like no one is listening

    1. Myrna, I am so sorry that you are going through this. I am not a doctor and I can’t prescribe anything specific. I do know that you should continue to look for answers! There are many things that can cause chest pain. I think this site is very helpful. Read all the way through….and then circle back with your current doctor and/or find another specialist to get a second opinion.

  9. I am new to this site, so bare with me as I ramble.. I am 50 years old and I am not sure if I am having “menapause” aches or if it is something else. I don’t want to go to the emergency room if I just have indigestion..So here it goes. Since last Thursday, I have had sharp pains in my upper back, (almost to where it burns) that moves to the front. My jaw started to hurt, I had a heaviness in my sternum, I am falling asleep at my desk and a squeezing sensation in the middle of my chest. All these aches and pains have come and gone since last Thursday! My family Dr has no openings any time soon. So, Any suggestions?

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