If you’re having a heart attack, you’re having chest pain—right?

Actually—there is a large group of people to whom this does not necessarily apply. I can guarantee we each know at least one person in that group.

This group is women.

A heart attack, or MI (myocardial infarction) occurs when the blood flow in the arteries supplying the heart muscle with oxygen and nutrients decreases to a critical level. This may be caused by:

• Arteriosclerosis—the forming of plaques inside the vessels, which causes decreased flow. Heart damage can be sudden.
• Angina—a less obvious condition causing narrowing of the coronary arteries resulting in insufficient blood flow to the heart muscle under physical (or sometimes emotional) stress. This form of chest pain may be dismissed because it causes right or left upper abdomen pain, but not chest pain. Angina can be a subtle warning, or an acute attacker. Take it seriously.

Often the diagnosis of acute MI is dismissed if chest pain is absent. This is based on the fact that chest pain is the hallmark symptom of MI’s in men.

But women are different when it comes to heart attacks. So if you are a woman, or love a woman, or have ever met a woman, there are some things you should know.

• 43% of women having an active, acute MI have nochest pain
  • There are many symptoms of MI in women as we will see, but studies indicate that chest pain is an unreliable symptom in making a diagnosis of heart attack in females.
• If you have chest pain, shoulder pain, or neck pain when you exercise, stop your exercise regimen until you see your doctor. No kidding. This may be nothing, or it could kill you. Is it worth that risk?
• An MI may occur in a young woman. The youngest woman having an MI in my office was eighteen years old, and presented with shortness of breath, and right shoulder pain when she was on the treadmill. She had no other symptoms, and came in for another problem. She just happened to mention these symptoms.
• Not all doctors understand that almost half of the MI’s occurring in women are silent. This means you have to be proactive. Ask for testing to be done if you are having a number of the symptoms below. Insist on it if your doctor says it isn’t necessary. If he still won’t do it, find another doctor. His reassurance that there is nothing wrong with you is of no comfort if you’re dead.
• Testing may include:
  • Cardiac Enzymes from blood work
  • An ECG in the office
  • Possibly an ultrasound of the heart, especially if there is a murmur
  • CT scan Calcium Score
  • CT scan angiogram
  • Stress Test with or without Thallium
  • Heart Catheterization

So how do you make a decision about your heart? The more common symptoms of heart attack in women are:

• Shortness of breath (58%)
• Weakness (55%)
• Unusual fatigue that won’t go away no matter how much you rest (43%)
• Nausea and Dizziness (does not necessarily indicate MI, but is a piece of information)
• Lower chest discomfort that is often vague and difficult to describe
• Upper abdominal pressure or discomfort, often mistaken for indigestion
• Back pain, dull in character without injury or pain with urination.

There are many causes for these symptoms other than MI, but if a number of them are present, or if they are persistent, they should be evaluated further as soon as possible.

Please feel free to ask questions or leave comments below.