Sneaky Symptoms and Weird Heart Attack Triggers in Women


In 1964, the American Heart Association (AHA) held its first conference specifically geared to women. The theme? “Hearts and Husbands.” Okay, well it was supposed to be geared toward women.

How much things have changed. Or have they? Heart disease is the number one killer of both men and women. In fact each year one in four deaths among women are due to heart disease – about the same number as men. And yet only 54% of women surveyed are aware that heart disease affects them as much as it does men.

How can this be? How does a disease that kills more women than breast cancer not register? In spite of yearly awareness campaigns such as the American Heart Association’s National Wear Red Day on February 6, studies have shown that we, as women, drastically underestimate our risk of cardiac disease. Not only that, but we delay seeking care. I know of so many women who tell me that their husbands refuse to see a doctor – women can be equally guilty! Since the symptoms of heart disease can often be vague, or mimic other conditions, it can be confusing to know when to seek care. Here’s what you need to know:

Symptoms: We’ve heard a lot in the news about how women and men have different heart attack symptoms. That’s not entirely accurate. Chest pain is still the most common symptom. It can include tightness, heaviness or just a feeling of pressure on your chest in both men and women. Also consider pain in your neck, jaw, shoulder and upper back. But women especially should think beyond simply “pain.” The pain should be especially concerning if it’s accompanied by fatigue, nausea, shortness of breath or just a cold sweat.

Another important distinction is that women may experience fatigue, nausea, shortness of breath or a cold sweat without chest pain – and they may be having a heart attack. In one study 42% of women had no chest pain during a heart attack. So while chest pain should raise a red flag so, too, should the other symptoms just mentioned.

Triggers: While heart attacks in men are typically triggered by physical exertion, women are also likely to have other triggers such as stressful events, anxiety and even sleep. (I’m not telling you to avoid sleep, but if you awaken with symptoms of heart attack as described above, you should take them seriously.) And there is such thing as broken-hearted syndrome (for those interested, the medical term is takotsubo cardiomyopathy), which, though rare, has similar symptoms. Takotsubo occurs when a person experiences a major stressor (such as an unexpected family death, domestic abuse or natural disaster). Scientists don’t know why but women do seem to be more vulnerable to these stressful triggers than men.

Risk Factors: While smoking is a risk factor for both men and women, it poses an even bigger threat for women. Metabolic syndrome (diabetes, high blood pressure, obesity and high cholesterol) and physical inactivity also present significant risks for women.

Here are five things every woman should do to reduce her heart attack risk:

  1. If you smoke, stop smoking.
  2. Know your own risk factors. After menopause, women have a higher risk of high blood pressure than men. So even if you’ve never had high blood pressure before, once menopause hits, it’s worth a visit with your doctor.
  3. Modify your lifestyle, if necessary. That means maintaining a healthy weight, eating a nutritious diet and getting regular exercise.
  4. If your doctor prescribes heart medications, take them and don’t skip a dose. Patients with heart problems that I see in the ER are often there because they missed a few days of their high blood pressure medication, causing their pressure to get dangerously high. Put your pills on auto-refill from your pharmacy or set a reminder to have them refilled two weeks before you’ll run out. Keeping your blood pressure, cholesterol and other risk factors in check will benefit your heart, your brain and your overall health.
  5. Finally, don’t ignore your symptoms. If you think there’s a chance that you could be having a heart attack, don’t wait. Seek help immediately.