Health & Medicine

For women, atypical heart attack symptoms may really by typical

Larry Todd Breeding
Larry Todd Breeding

More women die each year of heart disease than men, and this has been the case since the early 1980s. There are many proposed reasons for this fact, but one of the most important is the difference in heart attack symptoms for men and women.

Most women having a heart attack experience chest discomfort. However, compared to men, women are less likely to report chest pain and are more likely to downplay its significance. Moreover, just under half of all women having a heart attack deny having chest pain at all.

Women are more likely to complain of shortness of breath, nausea and fatigue as the most prominent symptom. Pain that women have during a heart attack may be in other areas such as the neck, jaw, back, shoulder or arm.

These “atypical” symptoms may mean that women could delay seeking medical attention. Also, medical providers may not recognize these symptoms initially as being part of a heart attack either, which could further delay treatment.

This delay, regardless of sex, has clearly been shown to worsen outcomes when treating heart attack patients. In addition, women with ischemic heart disease are falsely felt to have a lower risk and therefore may not be treated as aggressively as men who are matched by other criteria as having the same risk.

In general, women have more complications following a heart attack as well as more complications from invasive procedures used to treat heart attacks. There is a noted difference in outcomes related to age among women and men. Young women actually have a higher chance of dying while in the hospital for a heart attack than young men. However, older women may have a similar death rate or even a lower death rate, depending on the type of heart attack, than older men of the same age.

Again, this is thought to be at least partially explained by the differences in symptoms at the time of a heart attack onset between younger women and younger men.

Also, when younger women present with a heart attack, compared to men of the same age, the women are more likely to also have hypertension, diabetes, congestive heart failure or a prior stroke. All of these other serious conditions further increase their risk of a worse outcome compared to men.

Only with more public awareness of these “atypical” symptoms and presentations can everyone come to understand that for women these are “typical.”

Dr. Larry Todd Breeding, an interventional cardiologist with Baptist Health Medical Group Cardiology in Richmond, practices at Baptist Health Richmond.