Women and Heart Attacks: Know the Differences

Written by Dr. Chris Mason, American Physician Partners

Many women don’t know what a heart attack is supposed to feel like. Hollywood has skewed the perception. It’s not a falling down on your knees clutching your chest kind of thing. In reality, most women tend to experience other symptoms along with some chest pain, which often go ignored.

Historical Perspective

The reason why women ignore the symptoms? Only men get heart attacks, right?

Clinicians often unintentionally reinforce this mis-perception, suspecting indigestion rather than a heart attack. The absence of female subjects in medical textbooks and in research papers means many doctors simply don’t expect they will have to treat heart disease in women, or even how to recognize it. Many women say their physicians never talk to them about coronary risk, not recognizing the symptoms or mistaking them instead for signs of panic or stress. Those assumptions are particularly pronounced in the Emergency Department.

Symptoms and Timing

Women have smaller and lighter coronary arteries than men do.

This makes angiography, angioplasty, and coronary bypass surgery more difficult to do, thereby reducing a woman’s chance of receiving a proper diagnosis and having a good outcome.

Women experience non-typical symptoms of a heart disease more often than men including extreme fatigue, shortness of breath, nausea and neck and shoulder pain, as well as disturbed sleep patterns as much as a month or two before a heart attack.  During a heart attack, only about one in eight women reported chest pain, and described it as pressure, aching, or tightness rather than pain.

Women have different types of heart attacks than men.

While the majority of men suffer heart attacks caused by severe arterial blockage, women can have milder blockages, that may be hard to detect with traditional testing. Women can also have heart attacks caused by intense spasms of the heart arteries.

Women wait longer than men to call emergency services AND wait longer in the ED.

Women suffering a heart attack wait much longer than men to call emergency medical services and face significantly longer delays getting to a hospital equipped to care for them, putting women at higher risk for adverse outcomes. Once they arrive in the ED, women, on average, wait 3 minutes longer to receive an initial EKG and 7 minutes longer than men for a heart attack treatment protocol to be activated.

Young Women and SCAD

While the rate of heart attacks in the United States has gone down in recent years, studies show it has remained steady in people 50 and under. The cause?  A specific type of heart attack is the culprit-SCAD or spontaneous coronary artery dissection. SCAD is responsible for 40% of heart attacks in women under 50. Women who present with SCAD are healthy, thin and don’t have any of the standard risk factors. To complicate diagnosis, SCAD has no special warning signs.

SCAD is tricky. Regular heart attack treatment isn’t best. Stents, often used in standard treatment, can make things worse for SCAD patients, since they have tears in their arteries. Adapting to new standard heart attack assessment protocols is important to improve diagnosis rates.

Listen first

Whether it’s SCAD or another type of heart attack, the key to accurate diagnosis and quick time to treatment is to listen. Women can and do present with unexpected symptoms, most times there is a clue that can lead in the right direction.

Recognize the smallest signs and trust the collective knowledge of the ED team and their instincts to guide them to the correct diagnosis. Adapting new standard assessments, especially for heart attack types most prevalent in women (SCAD) means the difference between lasting recovery or heart attack recurrence.