Nausea. Extreme fatigue. Profuse sweating. Shortness of breath.
These may not sound like signs of a heart attack, but for women, they are.
“Women don’t always present like men do," says cardiologist Joseph Austin, M.D., medical director of cardiac rehabilitation at Carilion Clinic. "People think of crushing chest pain as a primary symptom of a heart attack or heart disease, but women are more likely to experience nausea, sweating and fatigue, perhaps accompanied by pain in the upper back.”
Why Recognizing Symptoms is Challenging
DeEtta Ray, D.N.P., F.N.P., B.C., is co-director of the Heart Failure Clinic at Carilion Clinic’s cardiology practice in Christiansburg.
“Women often write off their symptoms as something else,” she says. “If they experience severe fatigue, they tend to rationalize it—‘I’m a mother, I work a full-time job, I’m taking care of my elderly parents, of course I’m tired.’"
She describes their complaints as "pain in the arm or shoulder blade, or a burning sensation in the throat, but they don’t typically experience the ‘elephant sitting on my chest’ feeling that men more often have.”
Furthermore, Compton points out that some of the symptoms of menopause mimic those of a heart attack.
Women are more likely to experience nausea, profuse sweating and fatigue, perhaps accompanied by pain in the upper back.
“Fatigue, hot flashes, and night sweats are all common complaints of women going through menopause, but they can also be signs of heart problems,” she notes. “Women often dismiss heart symptoms as menopause-related, stress or even panic attacks.”
Why Recognizing Symptoms is Essential
Recognizing those symptoms is crucial, because cardiovascular disease is the leading killer of women in the United States.
“More women die from heart disease than from all types of cancer combined,” Dr. Austin emphasizes. “This isn’t a new phenomenon. For almost 30 years, more women have been dying of heart disease than men. Yet for some reason, it is often still thought of as a man’s disease.”
Women are more likely than men not to survive their first heart attack. Dr. Austin attributes this to multiple factors.
“Women tend to develop heart disease later in life, so they’re likely to have other medical issues and not be as healthy,” he says. “Also, women often wait longer to seek medical attention.”
Other reasons are based sheerly on biology. Women’s arteries tend to be smaller than men’s and can become blocked with plaque more easily. Also, “women’s risk of coronary artery disease increases dramatically after menopause,” Dr. Austin explains. “Female hormones have a protective effect that disappears as women age.”
Know Your Risk
The first step women can take in reducing their risk of having a heart attack is to educate themselves.
“Know the risk factors and know if you have those risk factors," says Dr. Austin. "Know your family medical history. Seek medical attention if you have symptoms, and take steps to lessen any of the risk factors that can be modified.”
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Primary risk factors include:
- High blood pressure
- High cholesterol (especially when paired with low levels of HDL)
- Lack of exercise
- Age 50+ and/or post-menopausal
- History of heart problems in parents or siblings
Prior medical conditions can also be risk factors. For example, women who have undergone treatment for breast cancer are at a higher risk of developing heart disease. Radiation can cause hardening of the arteries and blood clots, and common chemotherapy drugs such as Herceptin (trastuzumab) and anthracycline can increase the risk of heart problems. HPV (human papilloma virus), better known for causing genital warts and most types of cervical cancer, is also linked to a higher rate of future heart disease.
Dr. Austin also advises people to monitor their capacity for exercise. "If suddenly you find yourself getting out of breath or fatigued going up a flight of stairs or carrying groceries—activities that hadn’t affected you before—you should see your doctor," he said. "Another warning sign is upper-back pain or arm pain triggered by exertion that goes away with rest.”
“Some risk factors aren’t modifiable—such as age, family history, and ethnic origin," he said. "But others are within your control: blood pressure, cholesterol, alcohol and tobacco use, and exercise.”