Women are less likely to survive their first heart attack than men. This may be because the symptoms differ between the sexes. Women are more likely to have a "silent" heart attack or display unusual symptoms.
Also, female biology creates unique risk factors for heart attack, as some diseases that increase risk, such as polycystic ovary syndrome (PCOS), are not present in male biology.
Symptoms of heart attack in women
Chest pain is the most common symptom of a heart attack.
Many people expect a heart attack to come on suddenly. But research suggests that women experience symptoms for several weeks before a heart attack.
A study published in 2003 of 515 women who had experienced a heart attack, reports 80 percent of women had at least 1 symptom at least 4 weeks before their heart attack.
Symptoms may be constant or come and go, and they may also disrupt sleep.
It is vital for a woman who experiences any of these symptoms to seek help immediately, as heart attacks can be fatal, regardless of whether symptoms are mild or severe.
Eight of the symptoms of a possible heart attack are:
1. Chest pain
The most common symptom of heart attack in both males and females is chest pain or discomfort.
It may be described as:
However, women can experience a heart attack without having any chest discomfort.
Some 29.7 percent of the women surveyed in the 2003 study experienced chest discomfort in the weeks before the attack. Also, 57 percent had chest pain during the heart attack.
2. Extreme or unusual fatigue
Unusual fatigue is often reported in the weeks leading up to a heart attack. Fatigue is also experienced just before the event occurs.
Even simple activities that do not require much exertion can lead to feelings of being exhausted.
Feeling weak or shaky is a common acute symptom of a heart attack in a female.
This weakness or shaking may be accompanied by:
- feeling lightheaded
4. Shortness of breath
Shortness of breath or heavy breathing without exertion, especially when accompanied by fatigue or chest pain, may suggest heart problems.
Some women may feel short of breath when lying down, with the symptom easing when they are sitting upright.
Excessive sweating without a normal cause is another common heart attack symptom in women.
Feeling cold and clammy can also be an indicator of heart problems.
6. Upper body pain
This is usually non-specific and cannot be attributed to a particular muscle or joint in the upper body.
Areas that can be affected include:
- upper back or either arm
The pain can start in one area and gradually spread to others, or it may come on suddenly.
7. Sleep disturbances
Difficulty getting to sleep and unusual waking may be issues before a heart attack.
Almost half of women in the 2003 study reported issues with sleep in the weeks before they had a heart attack.
These disturbances may involve:
- difficulty getting to sleep
- unusual waking throughout the night
- feeling tired despite getting enough sleep
8. Stomach problems
Some women may feel pain or pressure in the stomach before a heart attack.
Other digestive issues associated with a possible heart attack can include:
Heart attack post-menopause
Post-menopause heart attack symptoms include:
- pain or discomfort in the arms, back, neck, jaw, or stomach
- rapid or irregular heartbeat
- severe chest pain
- sweating without activity
Risk factors for a heart attack in women include:
- Age: Those aged 55 years or older are at greater risk of heart attack. This may be because hormones provide some protection from heart disease before menopause.
- Family history: Those with a male relative who had a heart attack by the age of 55 years old, or a female relative who has had one by 65 years of age, are considered to have a family history of heart attack and are at increased risk.
- Health status: Certain markers, such as high blood pressure and high-cholesterol, increases the risk of heart attack in both males and females.
- Medical conditions: Those with conditions, including diabetes, obesity, and autoimmune disorders are more likely to have a heart attack. Diseases such as endometriosis, PCOS, or a history of preeclampsia during pregnancy also increase risk.
- Lifestyle choices: Using tobacco or stimulant drugs, for example, cocaine or amphetamines, a sedentary lifestyle, or high levels of stress will all increase the risk of heart attack.
When to see a doctor
The British Heart Foundation recommend all women over 40 years of age have regular checks with their doctor. This helps identify risk factors early so that they can be treated. Early intervention reduces the chances of a cardiac event.
Anyone who notices the warning signs of a heart attack, such as the following, should see a doctor immediately:
- unusual fatigue
- shortness of breath
- upper body pain
A doctor will note symptoms, check blood pressure and heart rate, and may order blood tests or use an electrocardiogram (EKG) to see the heart's electrical activity.
When to call emergency services
Anyone who suspects symptoms of a heart attack should call emergency services immediately.
Only 65 percent of women would call emergency services if they suspected they were having a heart attack, according to a 2012 survey.
Emergency treatment can save lives. Anyone noticing the following symptoms should call an ambulance immediately, especially if the signs are present for 5 minutes or more:
- chest pain or discomfort
- pain in the upper body, including arms, back, neck, jaw, or shoulder
- difficulty breathing
- extreme weakness
- indigestion or heartburn
- rapid or irregular heartbeat
- shortness of breath
- unexplained anxiety
Tips for better heart health include:
- Going for regular health check-ups with your doctor.
- Taking steps to manage other health conditions, including high blood pressure, high cholesterol, and diabetes.
- Quitting smoking and avoiding tobacco in any form. Heart disease risk reduces by 50 percent just 12 months after someone quits smoking.
- Not using illegal drugs, especially stimulants, such as cocaine and amphetamines.
- Losing weight if overweight.
- Engaging in at least 30 minutes of aerobic activity, such as walking, every day.
- Eating a balanced diet and visiting a dietician if necessary for dietary advice.
A heart attack is a serious and potentially fatal medical event that requires emergency treatment. Women tend to display different heart attack symptoms than men. They also have additional risk factors.
There are many steps women can take to reduce their risk of a heart attack. An awareness of the symptoms of heart attack, especially in the weeks before the event, can also improve outcomes and prevent complications.