When you think of a heart attack, the image that probably comes to mind is someone clutching their chest or experiencing numbness in their left arm. Whether you meant it or not, that image conjured up was probably a man.
For a time, heart problems were considered a male disease. And with good reason — heart disease is leading cause of death in American men. But that doesn’t mean women are immune to heart problems.
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We now know that heart attacks pose a risk to both men and women. As a matter of fact, One in five women dies from heart disease. Older women are particularly at risk. The National Institute of Health (NIH) reports that older women are more likely to suffer heart attacks than men. Menopause is probably the culprit, as the drop in estrogen increases abdominal fat, high blood pressure, and other factors increase a person’s risk of clogged arteries.
“Misdiagnosis and undertreatment are key to the fact that women are more likely to die from heart disease than from all cancers combined,” he says Suzanne Steinbaum, MD, a cardiologist specializing in women’s health during menopause. “If risk factors are present and a woman is postmenopausal, she should be evaluated for signs of plaque in the arteries.”
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The problem is that the typical symptoms we associate with heart attacks, such as chest pain, are more common in men than women. A now much-cited NIH study from 2003 found that only 30 percent of the 515 women surveyed had any chest discomfort while suffering a heart attack.
Heart attack symptoms in women can be worryingly more vague and subtle. But as problematic as heart attacks are for women, they are among the most preventable diseases. Recognize early warning signs can help slow down an impending heart attack.
Extreme and unexplained fatigue is one of the most commonly reported heart attack symptoms in women. That’s because your heart is under tremendous strain as it tries to pump blood into a congested area.
In the NIH study, 70 percent of women reported a bout of fatigue that started one to two months before the actual attack. The fatigue should be so damaging that it interferes with your daily activities.
“It’s so severe for some that they can’t make a bed without resting while tucking the sheets shut. It interferes with their normal activities.” Jean C McSweeney, PhDa professor at the University of Arkansas for Medical Sciences at Little Rock said NBC News.
If you suddenly have trouble sleeping at night, your body could be warning you about high blood pressure. High blood pressure is one of the main risk factors for a heart attack. Normally, blood pressure drops during sleep but if you have trouble sleeping, it remains elevated. A 2023 learn In Clinical Cardiology found that insomnia and less than 5 hours of sleep are associated with an increased risk of heart attack after years.
When you wake up, your Heart rate and blood pressure spikes cause cardiac stress as your heart works harder to get you up and moving.
Back, neck or jaw pain
When an artery becomes blocked and blood flow is blocked, sufferers may experience tremendous pressure or chest pressure. Women feel the painful pressure more often than men in other places like the upper back, neck, jaw, and shoulder blades. “If it happens on exertion, it should be taken seriously. One of my patients said that her shoulder hurt every time she walked. She thought it was her purse but her shoulder hurt even though she wasn’t holding it.” Radha Kachhy, MDsaid a cardiologist DukeHealth.
The uncomfortable pressure can start insidiously or intensely, and even come and go before it becomes impossible to ignore.
Heart failure can cause swelling of the abdomen, which can present as an indigestion. Nearly 40 percent of women report indigestion one month before the cardiac event.
Other telltale signs that are often overlooked are nausea, loss of appetite, and vomiting. Vomiting due to heart problems is called cardiogenic vomiting. When the heart is too damaged or unable to take in oxygen-rich blood, Heart tissue begins to die. The dying heart cells release toxins that stimulate the nerves responsible for vomiting and make your stomach feel nauseous.
“Heart attacks are more likely to be missed in women and present as nausea and vomiting in women more than men,” said Dr. Jeffrey Ko, Assistant Professor of Clinical Health Sciences UC Davis Health. “If you are a woman over 50 and have other factors such as diabetes or obesity and are experiencing these symptoms, it is advisable to go to the nearest emergency room.”
Past experience shows that waking up with chills, sweating, and feeling light-headed means you’re catching the flu. In women, however, the flu-like symptoms could indicate an impending heart attack.
Julia Allen shared her story of a heart attack she suffered at the age of 44 women health . At first she mistook it for the flu. “I felt the flu symptoms immediately and intensely (almost like someone closing the door on me). Remember, all of my flu symptoms were EXTREME. I felt tired, weak, dizzy and nauseous.”
Liz Johnson – then 39 – told the American Heart Association how her flu-like symptoms affected her ability to teach. She later went to the emergency room, where it was determined that she was having a heart attack. The flu-like symptoms Liz experienced are common in people with spontaneous coronary artery dissection (SCAD). It causes a tear in the artery wall, causing blood to pool between the layers of the artery wall. The resulting bulge in the wall blocks blood flow and damages the heart muscle. SCAD can occur at any age but is most common in women between the ages of 30 and 50.
Fear is a way of life for most Americans in today’s society. More than 40 million adults have an anxiety disorder. However, if you notice unusual bouts of stress or a feeling of “doom and gloom,” take a minute to breathe. Your fear may be trying to tell you something.
Thirty-five percent of the women in the NIH study reported feeling anxious during their heart attack. And unlike a panic attack, the fear-like feeling won’t go away. The intensity can even increase over time. The fear of an impending heart attack is also accompanied by other physical symptoms.
Image: Terese Condella/SheKnows
A version of this article was originally published in December 2016.
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