Grasping heart disease: How to recognize women’s symptoms

Heart disease is the number one killer of women in the United States, claiming more female lives than all forms of cancer combined. Many women fail to recognize the warning signs because women’s symptoms are often elusive and can go unidentified.

“Women’s symptoms are not always like the Hollywood version of a man gasping for breath, clutching his chest or left arm, and falling to the ground,” said Mary Alice Middlebrooks, M.S.N., RN, who specializes in cardiac intensive care and is an assistant professor at the Texas A&M Health Science Center (TAMHSC) College of Nursing. “In fact, women’s symptoms often present themselves in advance of an actual heart attack and many times women don’t realize they are in danger.”

She explained that female symptoms are often more subtle than their male counterparts. Female myocardial infarction, or heart attack, symptoms may include lower chest or upper abdominal pain, back pain, dizziness, lightheadedness, neck pain, jaw pain, difficulty breathing, difficulty sleeping, nausea, sweating, vomiting and/or extreme fatigue.

The reason for these differences in symptoms can be attributed to the difference in heart disease between the sexes. Men often experience blockages in the main stems of coronary arteries, while women more frequently develop blockages in smaller branches off of the main coronary arteries.

In addition to different and/or more subtle symptoms, some women have reported experiencing initial symptoms earlier, as much as one month before a heart attack. These warning signs are often felt several times a week, or even daily, and may be as understated as fatigue, sleep disturbance, shortness of breath and indigestion. Women with these early symptoms may also experience chest pain, but unlike men, often describe it as pressure, aching or tightness. Likewise, recognizing strokes in women has, historically, been far more complicated than identifying strokes in men. With both myocardial infarctions and stroke, when a woman’s experience does not correspond with more predominant symptoms, she can lose precious time by waiting to seek treatment.

“Heart attacks in women are so deadly because many women simply do not understand the indicators unique to women, and often do not communicate these symptoms well with their medical provider,” said Deborah Shirey, D.N.P., APRN, FNP-BC, assistant professor at the TAMHSC College of Nursing with experience in emergency, urgent care and internal medicine.

 “While women need to understand these differences, it is critical for those of us in healthcare to listen to what our patients tell us, be able to recognize even the most subtle cardiac symptoms, and always consider the possibility of myocardial infarction,” she added.

In addition to her professional experience, Shirey has a personal history with heart disease. Both of her parents and sister have suffered myocardial infarctions. “Like many women with a strong family history of heart disease, I must be responsible for my own knowledge and well-being. I believe that my personal experience drives me to emphasize the importance of prevention in educating patient populations about heart disease,” Shirey explained.

Women with hypertension, family history, elevated triglyceride levels, lipid abnormalities, diabetes, premature menopause and/or smoke are especially at risk for cardiovascular disease. Identifying risk factors and then combating those risk factors, combined with a dedication to a healthy lifestyle remains the best prevention. Additionally, knowing the warning signs of myocardial infarction can help women receive treatment earlier, and reduce the number of lives lost to heart disease.