Be Proactive Regarding Your Hearts, Ladies!

By: Susan Salenger • Posted on February 08, 2024

Approximately every 40 seconds, someone (men and women) in the United States will have a heart attack. It’s the leading cause of death among women and over 60 million women, forty four percent of us, are living with some form of heart disease. The CDC reports that only about half (56 percent) of US women recognize that heart disease is their number 1 killer. Even worse, only 22 percent of primary care physicians and 42 percent of cardiologists feel well prepared to assess a woman’s risk for cardiovascular disease.  That means that some, if not many, of these deaths might have been prevented.  

In short, heart disease is nothing to mess around with. And yet, in a sense, that’s exactly what’s happening.

Women are stigmatized as being anxious. But women’s heart attack symptoms are different from men’s so when traditional tests—based on men’s bodies—show everything is “normal,” female heart patients are often told their symptoms must be anxiety or reflux. To make a bad situation even worse, some of the tests that doctors need to diagnose heart attacks in women are not readily available which, of course, leaves women in a precarious position.

The problem is that when it comes to our hearts, time is of the essence. Delays and misdiagnoses can cause serious damage to your heart muscle. The saying, “Time is muscle,” means the longer women wait to get evaluated, the more likely it is they may suffer irreversible heart damage. 

Recognizing a Heart Attack

Women’s cardiac symptoms differ from men’s. For many years, women were not allowed to participate in clinical trials. That means much of the data regarding heart disease is based on white cisgender men which results in some doctors being less familiar with women’s symptoms.

Women themselves are another surprising reason heart disease in women is difficult to diagnose and treat in a timely manner. Women also have trouble identifying heart attacks and we can inadvertently cause our own delays. Women can begin having heart attack symptoms weeks before their heart attack actually begins and those beginning symptoms can be hard to identify. Because our heart attack symptoms are more subtle than we expect them to be, women are significantly more likely than men to wait before going to the hospital. Despite the drama we’ve all seen of heart attack victims who grab their chests in pain and then slump to the floor, women often don’t have any chest pain or discomfort. In one study, 62% of the women who had heart attacks experienced no chest pain compared to 36% of the men. Many women complained of nausea, indigestion, and shortness of breath instead.  

Some people, in fact, who have a heart attack have no symptoms at all—or symptoms that are so subtle they're mistaken for something else entirely. According to the American Heart Association, these “silent heart attacks” account for about 20 percent of all heart attacks and some experts estimate that percentage is even higher—closer to 50 percent.

Heart attacks that have no accompanying chest pain are especially difficult to identify. Instead of chest pains, women may experience a variety of other symptoms many of which mimic other common, less serious illnesses. It can be difficult, if not impossible, to differentiate them. But it’s important to stay alert and know that, if you are having a heart attack, every minute of delay increases your chances of heart damage and death.

Heart attack symptoms to watch for

The New York Times listed some symptoms to watch for:

• Neck, jaw, shoulder, throat, upper back or upper belly (abdomen) discomfort  
• Facial pain or burning or toothaches
• Shortness of breath
• Pain in one or both arms
• Nausea or vomiting
• Sweating
• Lightheadedness or dizziness
• Unusual fatigue
• Heartburn (indigestion)

Time is critical in treating a heart attack and a delay can result in permanent heart damage or death. 

Women also don’t consider themselves as vulnerable as men to heart conditions and, like their doctors, are more likely to dismiss their symptoms as stress or anxiety. We just don’t think of our hearts as a potential cause of our symptoms. But heart attacks are rising even among younger women, particularly between the ages of 35-54 and that, of course, makes a diagnosis even trickier. Since the women are so young, it may not occur to them or their doctors that a heart attack is a possible explanation for what’s going on. And symptoms in younger women can be even less typical. For example, younger women have even less of that elephant-on-the-chest-feeling that we see in movies. They’re more likely to experience the more general symptoms of indigestion, nausea, shortness of breath and fatigue. That’s why, regardless of our age, heart attacks can be so tough to diagnose accurately.  

But it’s important to know the different ways heart attacks can look since treatment works best if it’s given early on, preferably within one hour of when symptoms begin.   

Treating a Heart Attack

But even when women think they might be having a heart attack, even when they call their doctors and get to the hospital in plenty of time, women have a harder time getting treated than men do. Health care providers downplay women’s symptoms and may delay treating them. Women are more likely than men to be told that their symptoms are all in their heads and one study found that women who complained of symptoms consistent with heart disease—including chest pain—were twice as likely to be diagnosed with a mental illness compared to men with identical symptoms.  

In fact, women who complained of chest pain had to wait on average 11 minutes longer to see a doctor or nurse than men who complained of similar symptoms. They were less likely to be admitted to the hospital, received less thorough evaluations and were administered tests like an electrocardiogram (EKG) which can detect cardiac issues less often. They were also recommended less frequently to cardiac rehabilitation programs which improve outcomes and have a higher rate of survival.   

What to do When You Think You’re Having a Heart Attack

Here are some suggestions about what to do when you think you’re having a heart attack:

1. Call 911 immediately. DON’T go to the hospital yourself. That’s because when the paramedics arrive, they will begin treatment immediately. By driving yourself (or having someone drive you), you are delaying your treatment.

   The 911 dispatcher is a great resource. They can simultaneously send an ambulance and collect information about your symptoms. That way when the paramedics arrive, they already know what’s going on.

2. Once you’re in the emergency room, request to be seen asap. If you’re having a heart attack, time is of the essence. Time delays are not your friend.
3. If you think you’re having a heart attack and are diagnosed with stress, a stomach issue or anything else, request an electrocardiogram. An EKG is the fastest way to detect whether you are having a heart attack. You need an accurate diagnosis in order to get appropriate treatment. 

Remember, heart attacks are not something to mess around with. Get yourself help immediately and, more than likely, you’ll make a good recovery.

Be Strong, Be Healthy, Be in Charge!
-Susan Salenger, author and researcher behind Sidelined: How Women Can Navigate a Broken Healthcare System

References:

1. Chen, J. (2023). 9 Sneaky Female Heart Attack Symptoms Women Might Be Ignoring. The Healthy, Reader’s Digest.    
2. O’Connor, A. (2022). "Why Heart Disease in Women Is So Often Missed or Dismissed ". from https://www.nytimes.com/2022/05/09/well/live/heart-disease-symptoms-women.html.
3. Antipolis, S. (2021). Heart Attack diagnosis missed in women more often than in men, European Society of Cardiology.
4. O’Connor, A. (2022). "Why Heart Disease in Women Is So Often Missed or Dismissed ". from https://www.nytimes.com/2022/05/09/well/live/heart-disease-symptoms-women.html.    
5. "Heart Attack Information for Women." OASH Office on Women’s Health https://www.womenshealth.gov/heart-attack/facts.    
6. Moyer, M. W. (2022, June 22, 2023). "Women Are Calling Out ‘Medical Gaslighting”." from https://www.nytimes.com/2022/03/28/well/live/gaslighting-doctors-patients-health.html.
7. O’Connor, A. (2022). "Why Heart Disease in Women Is So Often Missed or Dismissed ". from https://www.nytimes.com/2022/05/09/well/live/heart-disease-symptoms-women.html.    

8. Mateo-Rodriguez, I., et al. (2021). "Gender Differences, inequalities and biases in the management of Acute Coronary Syndrome." Journal for Healthcare Quality 37(3): 169-181. 

    

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