February 23, 2021

How heart attack symptoms differ in men and women

GREENVILLE, S.C. (WSPA) – According to the Centers for Disease Control and Prevention, heart disease is the leading cause of death for men and women in the U.S., but only half of women recognize it as their top killer.

Bon Secours S. Francis Registered Nurse Meredith Thackston said many of her patients know heart attack symptoms that are typically seen in men, but that women often have very different symptoms and many don’t know what they are.

“Your classic symptoms are ‘there’s an elephant sitting on my chest and I can’t breathe,” she said. “Some people just have back pain, shortness of breath, palpitations that are accompanied by lightheadedness, dizziness [and] passing out. Women tend to present with more [gastrointestinal] symptoms… upset stomach, nausea, sweating, lightheadedness, dizziness, and feelings of impending doom, which tends to appear more like anxiety,” she said. 

According to the American Heart Association, research shows these differences between men and women:

  • In certain women, especially younger ones, the plaque doesn’t bulge as much into the artery, making it less conspicuous and harder for doctors to diagnose on routine tests. But it can still form a blood clot and lead to a heart attack.
  • During a heart attack, women and men often feel chest pain, but women may experience uncommon symptoms such as back, arm, neck or jaw pain, or have nausea, weakness and a sense of dread.
  • Women wait longer to get treated. The median delay is about 54 hours in women and 16 hours in men.
  • Both sexes share heart attack risk factors, but Type 2 diabetes and high blood pressure are more potent for women.
  • Women who survive a heart attack are more likely to have complications in the hospital such as shock, bleeding or heart failure. Mehta said some physicians do not follow medical guidelines and some women do not take prescribed medications or participate in cardiac rehabilitation, which can result in long-term complications.
  • Depressed women have a 50 percent higher risk of heart attack. It’s unclear how depression raises risk, but depressed patients are more likely to not follow a healthy lifestyle.

Thackston has seen many women confuse their symptoms, such as a sense of impending doom, with anxiety and urges women to see a doctor if they suspect something is wrong.

“Women tend to wait longer to go to the hospital, which is part of the problem because those symptoms are not your typical heart attack symptoms because of that they can have more damage,” she said. 

She added that awareness of the gender differences in heart disease symptoms has increased in the medical community in recent years.

“I think [doctors are] a little more aggressive in not only recognizing but diagnosing and treating. Women are at much higher risk after menopause… prior to menopause they do have that protective estrogen, but after that, the risk does go up to that of men,” she said.

The American Heart Association reported that women who smoke and are on birth control pills increase their risk for heart disease by 20 percent and that family health history is another big risk indicator for both men and women.

“First degree male relative puts people at higher risk,” Thackston said, and urged those with brothers or fathers diagnosed with heart disease or who have had a heart attack to be proactive about keeping their hearts healthy.

“Don’t wait for symptoms to start,” she said. “Start monitoring your blood pressure. Get your cholesterol checked. Stop smoking. Exercise 5-7 times a week. Those are critical.”

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