“The absence of chest pain does not mean that it’s not your heart.”
When you think about a heart attack, you probably picture someone clutching their chest and falling to the ground with their breath totally knocked out of them. But the truth is, especially for women, symptoms of a heart attack can be much more subtle, which means those symptoms can often go untreated.
Although heart attacks are often thought of to be more common in men, heart disease is actually the number one killer of both men and women, accounting for about 1 in 4 deaths in women in the U.S., according to the Centers for Disease Control and Prevention.
But even though heart attacks are so common in women, there’s still one big problem: “There’s the perception that a woman would never think she’s having a heart attack, so she’s going to think it’s everything else but,” says Marla Mendelson, MD, associate professor of cardiology at Northwestern Medicine. (Read up on how one cardiac nurse ignored her heart attack symptoms for nearly a week.)
In order to be able to recognize when it could be happening to you, it’s important to first understand what exactly a heart attack most commonly is. “Essentially what’s happening is that the arteries in the heart are unable to provide sufficient blood flow to the working heart muscle, and most commonly this is due to atherosclerosis, this plaque that builds up in the arteries,” says Erin Donnelly Michos, MD, associate director of preventive cardiology at Johns Hopkins Medicine.
And although plaque naturally builds up over time, a heart attack occurs when that plaque ruptures suddenly, says Dr. Michos. “The plaque ruptures, and a clot forms suddenly,” she says. “And there can be a complete obstruction of blood flow down the artery of heart.”
When that obstruction or blockage happens, it causes the heart muscle to begin to die. “This is why it’s an emergency, because if the heart muscle dies, it doesn’t repair itself,” says Dr. Michos. “Time is muscle.”
That means it’s crucial for women to be able to detect some of the symptoms they might be experiencing during a heart attack, and since February is American Heart Month, now’s the perfect time to take note. Below are some of the most common heart attack symptoms all women should be able to recognize.
Because the heart sits on top of the stomach, it can be common to confuse a heart attack for simple indigestion. And, unfortunately, medicine has historically gotten this wrong for women, too.
“In 1991, there was actually a study that showed women who came into the emergency room with chest pain were treated differently than the men,” says Dr. Mendelson. “Women were sent home with antacids, and the men were sent to the cath lab,” she says.
And although medicine has now caught up significantly and has raised an increased awareness for heart disease in women, we as women still might hesitate to recognize a heart attack for indigestion if we’re feeling stomach pains.
“We still see women staying home because they have indigestion and treating themselves with antacid,” says Dr. Mendelson. So if you’re experiencing indigestion that feels abnormal or lasts for a more than a few minutes, get to a doctor right away.
Jaw and back pain
Everyone perceives pain differently, and everyone has different thresholds for pain. Because of that, it’s easy to confuse pain coming from the chest as pain coming from other areas, including the jaw or back.
“It’s not because the heart attack’s any different,” says Dr. Mendelson. “It’s the perception of the symptoms.”
Similar to indigestion, because of the positioning of the heart, it could be very easy to think you’re just having a simple case of heartburn. “The heart sits right on top of the esophagus in the stomach, so sometimes heartburn can feel like a heart attack, and a heart attack can feel like heartburn,” says Dr. Michos.
The important thing here is recognizing the time that passes. “If this is going on longer than five to seven minutes and you’re having ongoing discomfort that’s not going away with sitting and resting, and this is a new thing, this came on suddenly, you’ve never had it before, that’s sort of how a heart attack presents,” says Dr. Michos.
Shortness of breath
If you have shortness of breath after heavy exercise, that’s usually pretty normal. But if you’re experiencing shortness of breath when you’re just sitting on the couch, or if you’re unable to make it up the stairs, that could signal something more troublesome going on in your heart.
Even if that shortness of breath isn’t accompanied by chest pain, it could still signify a heart attack. “I always tell patients that if they think that something is wrong, they should seek immediate medical attention as everyone experiences a heart attack differently and the absence of chest pain does not mean that it’s not your heart,” says Amy Sarma, MD, a cardiologist at Massachusetts General Hospital.
Left arm pain
Both men and women can experience any of these symptoms, but left arm pain is often what we think of as the classic heart attack symptom. That’s because, similar to jaw and back pain, your brain can’t decipher where the pain is coming from.
“Because the nerve endings all come into the spinal column at the same place—from the upper arm, from the chest—the brain can’t pick out that it’s actually happening in the heart,” says Dr. Mendelson. “For example, if you prick your finger, you know exactly where you’re poking your finger. You don’t have that in the chest.”
Like indigestion, because the heart sits on top of the stomach, a heart attack can cause some nausea. “The heart’s your major, vital organ, and it’s not getting enough blood flow, and the heart muscle’s dying, and people feel incredibly sick,” says Dr. Michos.
But typically, a heart attack will cause a general sense of illness on top of that nausea, including feeling cold, lightheaded, and clammy. “It’s usually not just a little bit of nausea,” says Dr. Michos. So once again, if you recognize you feel unwell for more than five to seven minutes, get to the emergency room right away.
This is the most notorious sign of a heart attack: the feeling of an elephant sitting on your chest, or a feeling of sudden tightness near your heart. “It can have the pressure, the squeezing, the tightness in the chest,” says Dr. Michos. “That’s the typical presentation.” If you’re experiencing this, it’s important to get to a medical professional right away.
The bottom line: Recognizing all heart attack symptoms can save your life.
At the end of the day, although a heart attack can present in women as chest pain, it can also be much more subtle—and therefore possibly even more terrifying. “A heart attack is a scary thing,” says Dr. Mendelson.
“Prevention is the key, and we know that the things that prevent heart attacks in men also prevent heart attacks in women.”Among those things? You guessed it: eating well and exercising often. But you can also prevent a heart attack by getting regularly screened for heart disease.
And if you think you are having a heart attack? “It is important to call 911 and seek emergency medical care,” says Dr. Sarma. “Your doctors will perform various tests to see if you are indeed having a heart attack and, if so, what the cause of blocked blood flow is. Treatment is based on the underlying cause, but can include medications, stents, or cardiac surgery.”