heart disease symptoms in women

Warning Sign for Heart Attack Goes Unheeded in Women

Women who experience chest pain with no other signs of heart disease are at elevated risk for heart attack or stroke.

By Megan Othersen Gorman

Warning Sign for Heart Attack Goes Unheeded in Women

Listen to your heart: Chest pain should be taken seriously by woman and their doctors.

05-18-09 RODALE NEWS, EMMAUS, PA—Some women who have chest pain may not be getting the medical care they need, a new study suggests. File this under little-known medical facts: It isn’t uncommon for women complaining of chest pain to be found to have no plaque buildup inside their coronary arteries (a classic sign of heart disease, which is checked via angiogram) and to be sent home without treatment. “Actually, it’s quite common,” confirms Martha Gulati, MD, associate director of the Center for Women’s Cardiovascular Health at Northwestern Memorial’s Bluhm Cardiovascular Institute in Chicago, and lead author of a study that confirms that women with symptoms of heart disease often present differently than men.

“Women who have had a heart attack have a 20 to 30 percent chance of having normal coronary arteries,” she says. “Asymptomatic women (or, women with no symptoms of heart disease who have not had a heart attack) who undergo angiography because of an abnormal stress test have a 40 to 60 percent chance of having normal coronary arteries, despite symptoms and signs of ischemia [reduced blood flow to the heart]. This probably translates to more than 3 million women a year in the U.S. with this problem. Not a small issue at all.”

THE DETAILS: Dr. Gulati helmed a team of physicians who analyzed two previous studies of heart disease in women; the first group was followed for an average of 5 years, the second, up to 10 years. The five-year annualized rate for heart attacks was 16 percent among women with some coronary artery obstruction, 7.9 percent among women with normal coronary arteries, and 2.4 percent women with no previous symptoms of heart disease. Their conclusion: “Women with symptoms and signs of ischemia [reduced blood flow to the heart], including pain/chest pressure at rest or with exertion, relief with rest, shortness of breath on exertion, neck or jaw pain, or an abnormal stress test, are at elevated risk for heart attacks and stroke—even if an angiogram comes back clean.”

WHAT IT MEANS: “Women’s heart attack symptoms are often more subtle than men’s,” says Noel Bairey Merz, MD, director of the Women’s Heart Center at the Cedars-Sinai Heart Institute, and chair of one of the studies Dr. Gulati’s team used in their research. Subtle symptoms are still symptoms and should be thoroughly checked out. “For instance, men might complain about tingling in the arm, which is widely recognized as a sign of a heart attack,” says Dr. Bairey Merz, “whereas a woman might present with symptoms such as exhaustion or overwhelming fatigue. A physician who knows how men and women manifest heart disease differently would recognize that symptom as an indication to look further.”

Here’s what women should do to make sure their hearts get the proper care:

• Know the female-specific symptoms. The classic symptoms of a heart attack (read: the symptoms most commonly seen in men having a heart attack) are squeezing chest pain or pressure, shortness of breath, sweating, tightness in the chest, and pain spreading to the shoulders, neck, and/or arm. What women having a heart attack are more likely to experience, says Dr. Bairey Merz, is indigestion or gaslike pain; dizziness, nausea or vomiting; discomfort or pain between the shoulder blades; recurring chest discomfort; and a sense of impending doom.

• Don’t dismiss any symptoms. “Symptoms are symptoms,” says Dr. Gulati. “Some symptoms are more classically associated with heart disease, but for women more so than men, symptoms can also be atypical, and all symptoms should be evaluated.”

• Don’t let your doc dismiss them, either. “There still exists some bias among doctors to not think about heart disease in women, despite an educational push to help physicians recognize that heart disease is the number one killer of women,” says Dr. Gulati. “Many women with angina still don’t get a cardiac assessment; it is a major issue.” If you’ve had chest pain but an angiogram comes back normal, ask for further evaluation, she says. Dr. Bairey Merz seconds that: “Push back,” she says. “Insist on a second opinion. Write down your symptoms, present them to your doctor, and tell him or her that you believe these are symptoms consistent with heart disease in women.”

• Search out women’s heart clinics in your area. Go where doctors are trained to recognize the difference in male and female heart disease symptoms, if you can, suggests Dr. Bairey Merz.

Filed Under: STROKE

Published on: May 18, 2009

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It is nice to find a site

It is nice to find a site about my interest. My first visit to your site is been a big help. Thank you for the efforts you been putting on making your site such an interesting and informative place to browse through. I'll be visiting your site again to gather some more valuable information.

signs of a heart attack

symptoms of heart disease in women Women may not think they're at risk of having a heart attack–but they are but the truth is that many heart attacks start slowly, as a mild pain or discomfort.

Heart Attack

I went to the ER with symptoms, squeezing and pressure, shortness of breath, fatigue, pain in my shoulder and down my arm with dizziness. The er doctor did a blood test and a x-ray then told me there was nothing wrong with me. I feel as though he should have done a scan to see if there was anything else wrong. He said my blood tests were normal so he sent me home. Yet they didn't check my legs or my neck either. I am at home with the same symptoms. When I walk my heart squeezes so hard its difficult to breath. I'm young, but having parents who both have heart problems I am still concerned. My blood pressure was normal but my heart rate was unusually low and still squeezing. My oxygen levels were 94%. I feel like something is wrong. To bad that this happens to more women more often.

Cardiologist referral

The best answer anyone can give you is to check with your insurance company to find out if you need a referral to see a cardiologist. Anything else is just a guess and may cost you extra money.

If you don't have insurance then contact the Doctor you want to see and ask his office staff if a referral is needed.

chest pain

Every once in a while I get a sharp stabbing pain in my left breast...the last time it happened I took a low dosage aspirin. I haven't wanted to think it is heart disease, but I don't want to risk anything either.
Can I schedule an appointment with a cardiologist without a referral?

Heart Attack & Women

Great article. Women need to know the symptoms and take action if they have them. I presented my symptoms (occasional chest pressure when walking and unusual exhaustion at the end of my work day plus family history of one parent) to my primary care doctor - first I called, then I went in for an appt to speak with him. Both times my concerns were more or less brushed off. I took it upon myself to schedule an appt with a cardiologist and he discovered that one main artery within the heart was 95% blocked and I now have a stent. Thank goodness I acted on my own.

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