By now, you’ve heard that heart disease kills more women and men than any other disease. You may also have learned that it is important to call 911 when you are experiencing the symptoms of a heart attack, because “time is muscle” – the longer you wait, the more heart muscle you stand to lose.
You’re probably wondering how you’d know if you’re having a heart attack.
Never wrong to be prepared, you think – so you do what many of us would do these days: You do an Internet search of “symptoms of heart attack.” It’s an interesting exercise, especially if you do an image search. You will see many pictures of men clutching their chests and grimacing. You also will see lists of symptoms that are entirely different for men and for women.
If you’re a man, you may come away thinking that if you are not having “crushing chest pain,” then you are not having a heart attack. If you’re a woman, you may conclude that you are a different species altogether, because “your” heart attack symptoms may just be fatigue, or nausea, not chest pain at all.
Here’s the truth about heart attack symptoms: Most commonly, they do involve chest discomfort. Not necessarily crushing chest pain, more commonly pressure, heaviness, or tightness. Less commonly, they involve discomfort in any other area of the upper body. As an old teacher of mine once said, “anywhere between the jaw and the belly button.” A heart attack may feel like heartburn, or pressure between the shoulder blades, or a jaw ache, or a pain in your arms or shoulders. And even less commonly, heart attacks don’t involve any discomfort that can be localized at all. Some people just feel off, or have breathing difficulties, or feel like they will pass out.
What about the difference in heart attack symptoms between men and women? It’s a persistent myth that women’s heart attack symptoms are radically different from men’s. What is true is that there are two subtle differences: First, uncommon, “non-chest-discomfort” symptoms are slightly more frequent in women than in men. Second, women (and their relatives, and their physicians!) may not think that the chest, back, jaw or arm discomfort they are experiencing is a heart attack.
Moreover, people often experience their symptoms differently than the internet images would suggest. I can’t tell you how many times I have talked to a woman in our emergency room and she says, “I didn’t have chest pain, so I didn’t think I was having a heart attack!” Wait, you may say, you just told me that women commonly do have chest discomfort just like men! Yes, but in my experience they just don’t refer to their symptoms as “chest pain” as much. So I tend to ask, “Well, did you have chest discomfort? Heartburn? Chest pressure?” and more often than not she will agree, “Yes, my chest felt heavy, I just wouldn’t call it ‘pain’.”
Finally, what to make of the fact that some people (and, admittedly, more women than men), may just feel unusually tired, or nauseous, or short of breath when they are actually having a heart attack? Should you call 911 every time you’re tired? Hardly. Most people I have talked to who have had such atypical symptoms recognized, often in retrospect, that there was something different going on than ordinary fatigue. They felt ill, often without being able to pinpoint why. And that’s always worth getting medical attention for, because it is our job to help figure out what’s a heart attack and what isn’t.
Friederike Keating, MD, cardiologist, is Director of Nuclear Cardiology and Director of the Cardiac Care Unit at the University of Vermont Medical Center. She is also Associate Professor at the Larner College of Medicine at UVM.