Are heart attack symptoms different in women?
Dr Ghosh was invited by the team at patient.info to give his expert advice for this blog post on how heart attacks can present differently in women.
The warning signs of a heart attack in women
Authored by Gillian Harvey · Reviewed by Dr Sarah Jarvis MBE
23-Jun-18 · 6 mins read
According to the British Heart Foundation, 188,000 adults a year are rushed to hospital with a heart attack. But did you know that a great many of these are women? Although men are more likely to suffer a heart attack, 68,000 women per year are affected - and heart attacks remain the number one cause of death in women in the UK.
One of the issues faced by the medical profession is that women are less likely to seek help if they experience heart attack symptoms - perhaps due to misconceptions about the likelihood of this medical emergency.
His and hers
There is some evidence that women may experience different symptoms to men when having a heart-attack. Studies into these differences have yielded conflicting results, meaning the jury's still out as to the extent of gender differences in heart attack symptoms.
In one study, the main symptom reported by women who'd suffered a heart attack was that of shortness of breath, with other symptoms including unusual fatigue and dizziness. Other studies have concluded that the primary symptom - regardless of sex - is pain or discomfort in the chest.
This pain is "often described by patients as a belt tightening around the chest,” according to Dr Ghosh, consultant cardiologist at The London Clinic.
There are various theories as to why women might experience slightly different symptoms to men, but the true cause and extent of these differences are not yet known.
"It's possible that in women a heart attack comes on more gradually - in a matter of hours rather than the sudden acute problem often experienced by men," says Ghosh. "It's also possible that in pre-menopausal women, pain is lessened by the hormone oestrogen."
If you experience chest pain or any of the symptoms, it is important that you seek help as quickly as possible to minimise the risk of mortality or morbidity.
"Once you call 999 (UK) and mention you are having chest pain or a potential heart attack, an ambulance should be rushed out to you," says Ghosh. "The ambulance staff will do an ECG there and then, to see if you are experiencing a heart attack. They will then be able to take you directly to a heart attack centre, who will then carry out further tests and administer treatment."
So what treatments are available for heart attack?
"A heart attack is caused by a blockage in the artery," explains Ghosh. "If blood is not getting to the heart muscle, the rest of the heart can't compensate. So, what happens is that the pumping action of the heart deteriorates, depending on the amount of the heart that's been damaged. Early intervention is important."
For the majority of patients, after a heart attack has been confirmed, ultrasound will be used to look more closely at the heart. Usually, an angiogram will then be performed.
"This is where some dye is injected into the heart blood vessels with a catheter - a small plastic tube fed into the wrist or leg. This enables doctors to identify any blockages. Doctors can then insert a stent to open up the artery," explains Ghosh.
It happened to me
The lack of knowledge about the risks and symptoms of heart attacks in women led 39-year-old Louise Cave to wait over a week to seek the correct treatment. Cave, who experienced a heart attack in 2018, initially thought her symptoms were that of a chest infection.
"I'd had a cough and started getting a few aches and pains in the top of my back. I went to the GP who gave me steroids and antibiotics."
However, Cave's symptoms continued to worsen.
"For the next week, I probably had about 10 episodes of a strange 'restless' feeling. It would come across my chest and travel down both arms into my wrists. Looking back, I probably should have sought help, but I just put it down to the chest infection. I also had two episodes when I was driving and suddenly started to feel extremely tired. Both times I pulled over and was asleep within seconds."
When Cave returned to her GP for a review, she told her doctor about the symptoms she'd been experiencing.
"She was worried about the pain I was experiencing and gave me an ECG there and then. This came back abnormal, so she sent me to A&E."
At hospital, Cave was told that she had coronary heart disease and might have dropped dead at any moment! A couple of days later, she was treated for a blockage in the main artery for her heart.
"I have weight issues and have smoked in the past, so these might have had a part to play in my experience," says Cave. "I have three young children whom I adore, so I'm taking my health more seriously now."
When Jane Young (then 55) experienced chest pain after an argument with her brother in 2012, the thought that she was having a heart attack was far from her mind.
"At the time, I was fit and healthy, working out three times a week at the gym," she says. "When I arrived home after a stressful exchange, I told my husband I had chest pain, but we decided it was indigestion caused by the stress of the argument."
Unfortunately for Young, the pain she had experienced had been a heart attack.
"Then the next week I was sitting in my sitting room and I wanted to talk to my husband and no words would come out - I'd lost my speech. We sent for an ambulance. In A&E, the doctor told me I'd had a heart attack and stroke! I suffer from migraines with auras and was told that people with my condition sometimes experience a migraine-like spasm in the artery leading to the heart. Mine had started to throw off emboli (particles), and one had travelled to my brain and caused a stroke. I am now on ramipril (which relaxes the muscles around the small arteries) and take statins."
The warning signs
Whilst symptoms of heart attack can vary from person to person, the most common signs are:
Pain or discomfort in the chest area.
Pain spreading down one or both arms, or radiating to your jaw, stomach, neck or back.
A feeling of nausea, sweating, feeling dizzy or short of breath in conjunction with pain.
With survival rates and the risk of morbidity affected by the speed at which treatment is administered, it's clear that if you suspect you are having a heart attack, time is of the essence - whatever your gender. Don't delay - call an ambulance immediately (in the UK - dial 999).