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.
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!