What might I expect?: Women’s symptoms ‘seem unrelated to heart attack

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*This article is not medical advice. If you have concerns, please consult your physician or medical professional soon.   

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“Heart disease and stroke claimed the lives of 32,271 women in Canada in 2019—one woman’s life every 16 minutes,” reported the Heart and Stroke Foundation of Canada (HSFC) in “System Failure: Women’s heart and brain health are at risk,” February 1, 2023. Worldwide, every year, heart disease causes more female deaths than all cancers combined. The urgent need for change is clear.  

While men’s risk of death from heart disease is decreasing, women’s risk is on the rise. Much of the medical science of heart disease was gathered by studying men. While it is useful science, it did not account for the significant differences between men’s and women’s bodies and lives.  

The heart is a muscular organ, the engine working day and night to pump blood throughout the body, delivering oxygen and nutrients, and removing carbon dioxide and other wastes. The heart has chambers, valves, arteries and veins, and an electrical conduction system that regulates heartbeat timing. A closer look brings variations into focus, elements that were not researched when investigating heart disease.  

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The female heart is about 25 per cent smaller than a male heart. It has a higher heart rate and smaller arteries due to hormones. “Women’s arteries are more prone to blood clots or blockages and more difficult to repair,” said Canadian Women’s Heart Health Centre. (CWHHC) Female heart muscle texture is more finely-grained than men’s coarsely textured heart muscle, and women “have less plaque buildup in their arteries,” but “the plaque they do have tends to behave differently.” When a woman is in her early 20s, plaque may begin developing. 

General risk factors for women are similar to those of men, such as smoking, high blood pressure, diabetes, obesity, inactivity, and family history of heart disease, and then there are hazards inherent to being female. Pregnancy complications, early menopause, “systematic inflammatory and autoimmune disorders (rheumatoid arthritis, lupus),” and “polycystic ovary syndrome,” present risks, noted CWHHC.  

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When a heart attack is oncoming, a woman’s symptoms and signs are dramatically different from those of men. It is easy to imagine someone clutching their chest and gasping, as if they are being crushed by an enormous anvil. This is not a woman’s usual experience. A woman may have chest pain, but is more likely “to have symptoms that seem unrelated to a heart attack, such as nausea and brief pain in the neck or back,” according to Mayo Clinic. Her chest pain may feel like fullness or squeezing. Or she may not have any chest pain. 

Heart attacks are divided by types: STEMI, with complete blockage of blood flow in a coronary artery; or non-STEM, a partial blockage in a major coronary artery. “Myocardial infarction (heart attack) with non-obstructive coronary arteries (MINOCA) is a type of heart attack that is at least twice as prevalent in women than men,” said HSFC. “Women who experience stroke are at higher risk of dying than men — and if they survive, their outcomes are worse.” 

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Symptoms tend to appear when the woman is resting or sleeping. Along with “neck, jaw, shoulder, upper back or upper stomach pain,” indicators may be shortness of breath, sweating, unusual exhaustion, heartburn, pain in one arm or both arms, or a feeling of lightheadedness or dizziness. Nausea or vomiting may be present.  

If these symptoms appear, call 911 or get emergency help immediately, and do not drive yourself to the hospital unless there is no other method.  

Women may brush off symptoms and not seek help. Medical professionals may also dismiss the signs. “Physicians may look for other causes of a woman’s symptoms, without first doing appropriate tests to rule out cardiac issues,” said the “2018 Heart Report” by Heart & Stroke Foundation of Canada. “It may not be intentional, yet when there are differences in medical care for men and women across large numbers of patients, it is an indication there is still systemic bias.” Alarmingly, the report noted that “early heart attack signs were missed in 78 per cent of women.”  

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The physician or cardiologist will take the patient’s medical history and family history, perform a physical exam and assess symptoms. Diagnostic tests may be ordered, “ranging from a treadmill exercise test to sophisticated nuclear imaging,” said CWHHC.  Blood tests, electrocardiograms (ECG), wearing a Holter monitor for a couple of days may indicate heart disease.  

Scans such as Coronary Computed Tomography Angiogram (Coronary CT) gives “a three-dimensional image of the heart chambers and coronary arteries supplying blood to the heart.” A Magnetic Resonance Imaging test, with or without dye, records “still or moving pictures of your heart” so that medical professionals can see how well the heart is working. The sound waves of an Echocardiogram (ECHO) evaluate “the heart’s function, the valves, the aorta, the sac that surrounds the heart (pericardium), or as part of a stress test.” 

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Diagnosing women’s heart disease may be complicated. “Women are more likely than men to have a heart attack with no severe blockage in an artery,” stated Mayo Clinic, but if there are blockages, the condition is “not only in their main arteries but also in the smaller ones that supply blood to the heart.”  

Considered the Gold Standard of heart disease tests, the Coronary Angiography or Coronary Catheterization (CTA) is an invasive procedure and used “when your doctor has a strong suspicion for coronary artery blockages as a cause for symptoms,” said CWHHC. A special dye is injected through a small tube “inserted into an artery in the arm or leg and threaded through the aorta to reach the coronary arteries in your heart.”  

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Reaching early treatment may limit damage to the heart muscle. If you have called 911, treatment can be started in the ambulance enroute to the hospital. “Treatment for a heart attack may include medications, surgery, and lifestyle changes,” said HSFC. Among several types, medications may include aspirin, clot-busting drugs, nitroglycerin, blood thinners, statins (to lower cholesterol levels), beta blockers, and ACE inhibitors.  

Surviving a heart attack, complications appear again for female patients. In the recent past, women were less likely to be offered supports after a heart attack, and less likely to be prescribed cholesterol-lowering or blood pressure drugs. Adverse reactions to certain heart medications happen more frequently in women, and, “these reactions are more severe than men experience,” according to the 2018 Heart Report. Heart rhythm disorders from the drugs are a greater problem for women, and “women have twice the risk of bleeding complications from common treatments such as angioplasty.”  

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Women can take action for their own heart health. Enjoy a healthy diet, get enough sleep, and do regular exercise. Limit alcohol intake, do not smoke, avoid stress, and control blood pressure. Ask a healthcare professional for suggestions, because every woman has individual needs.  

Recognizing the inequities that women suffer regarding cardiac disease, members of the medical community are determined to make change. CEO of HSFC Doug Roth stated, “transforming the state of women’s heart and brain health will involve changing policies, systems, attitudes and behaviours.” Focussed on breaking through roadblocks, “Heart & Stroke is committed to working with our partners to ensure all women in Canada receive the care and support they need.”  

We all must strongly advocate for accelerated research into women’s heart health, for timely treatment, and effective ongoing care. If you think you or a family member or friend have the symptoms of heart disease, see a healthcare professional as soon as possible. You, or your spouse, daughter, mom, sister, or friend may avoid joining the statistics of distressing premature death.  

Susanna McLeod is a writer living in Kingston, Ontario.  

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