By CARDIOVASCULAR INSTITUTE TEAM, Beth Israel Deaconess Medical Center

Heart attacks are primarily a problem for middle-aged men, right? Think again. Every year, about 460,000 women in the U.S. suffer a heart attack.

And, while heart disease is the leading cause of death for both men and women in the U.S., the odds are stacked against women heart attack patients versus men.

(Credit: iStockPhoto)

(Credit: iStockPhoto)

“Research has shown that women are more likely to die from a heart attack than men,” says Loryn S. Feinberg, MD, FACC, a cardiologist and medical director of the Women’s Cardiovascular Health Program in the CardioVascular Institute at Beth Israel Deaconess Medical Center. “And they are also more likely to have another heart attack within five years following the first one.”

There are a number of possible reasons for increased risks for women, including age, symptoms and treatment delays, according to Feinberg.

The Age Difference

“Women generally begin to experience heart disease symptoms and events about 10 years later than their male counterparts,” Feinberg explains. “Men more commonly begin to have heart attacks in their 50s and 60s. The average age for women’s heart attacks is usually late 60s and early 70s.

“One reason for this may be the decline in estrogen levels after menopause, since estrogen helps keep arteries flexible and strengthens the inside of artery walls,” she adds. “Another reason is that older women may have additional risk factors like high blood pressure or bad cholesterol levels, which can also rise during and after menopause.”

Heart Attack Symptoms

The most common heart attack symptom is chest pain or discomfort. But there are also some less common symptoms that may signal a heart attack, including discomfort or pain that occurs in the back, one or both arms, or in the neck, jaw or stomach. Some people may experience nausea, dizziness, sweating or shortness of breath.

“For years, a number of researchers and members of the medical community believed that women were somewhat more likely than men to experience symptoms other than chest pain,” says Feinberg. “But a recent study has found that while women may present different symptoms at times, 90 percent of both men and women have chest pain as the main symptom of a heart attack. It’s still by far the most common symptom of an actual heart attack.”

To be precise, the study examined 2,475 patients, including 796 women, who visited emergency rooms at hospitals in Switzerland, Spain and Italy between 2006 and 2012. A diagnosis of heart attack was found in 18 percent of the women and 22 percent of the men. Researchers interviewed patients about their symptoms and compared males to females. They found that the overriding symptom was chest pain or discomfort for both sexes.

“Certainly there are times when other symptoms may indicate a coronary event,” says Feinberg. “For example, an older or diabetic woman may display atypical symptoms such as marked sleep disturbance, shortness of breath, profound fatigue, discomfort in the neck, jaw, back or upper arms.

“But the primary symptom that men and women experience is chest discomfort. This discomfort doesn’t have to be severe pain, it can be pressure that radiates up to the neck and may move into the back or shoulders or down the arm,” Feinberg adds. “Shortness of breath, nausea, fatigue, light-headedness and palpitations — the heart seems to be racing — are other symptoms. Nausea and shortness of breath can be particularly prominent symptoms in women. That may be part of the reason why it’s been tough to diagnosis women early. Women may have a little chest pressure, but they’re focusing on the nausea and the physician starts going down that path.

“The important thing for women to know is that there is a broad range of symptoms, and if they are not feeling well and have never felt this way before, particularly if they’re experiencing chest discomfort or shortness-of-breath symptoms, they need to seek help.”

The Delay Factor

A tendency to delay medical care is a more preventable, but nonetheless disturbing, factor in more serious heart attack outcomes for women. One study found that women, particularly those over 65 years of age, are more likely to delay getting medical help than men. Another researcher, who interviewed 52 women hospitalized for heart attacks, found that most of the women delayed seeking medical care for time periods that ranged from 15 minutes to as long as two weeks after symptoms began.

“Sometimes women make excuses for not addressing their symptoms since they are so busy taking care of others in their lives,” says Feinberg. “There’s also an element of denial here, which may involve women not believing that they are at risk for heart disease and attributing the symptoms to something else. The truth is that one in four women die of heart disease, so the risk is very real.”

Another factor can involve a tendency for patients at home to wait longer to get help in comparison to someone in an office setting, according to Feinberg, who explained that older heart attack patients may be retired and at home with more resources to try to relax and feel better when the symptoms strike.

“The trouble is that any delay can increase heart damage,” explains Feinberg. “It’s important to get medical intervention for a heart attack within one hour after symptoms begin.”

If You Have Symptoms

If you do suspect that you’re having a heart attack, the best thing to do is get to the hospital quickly, preferably by ambulance.

“Calling 911 has many important advantages,” says Feinberg. “Emergency medical technicians can use a defibrillator in case of cardiac arrest. Some can start intravenous fluids and give medications. Some ambulances have EKG (electrocardiogram) equipment on board to help initiate the work-up for a heart attack. They can then call ahead to the accepting ER to alert them of this diagnosis, if suspected based on the EKG.”

Feinberg also recommends that patients with heart attack symptoms immediately chew four baby aspirin or one adult-strength aspirin to help prevent blood clots, which may help to keep a blocked artery partially open.

“Chewing it will get it into your bloodstream quicker than swallowing it,” she explains. “The brand doesn’t matter, as long as it’s uncoated.”

After Arrival in the ER

Feinberg explains that emergency room physicians are now advised not to diagnose based on heart attack symptoms — they need to pursue testing. Anyone presenting heart attack symptoms at a hospital requires an EKG and blood tests to determine if cardiac muscle damage has occurred, regardless of symptoms or the sex of the patient.

“When we think about defining heart attack symptoms — including the type, location and intensity of pain — it’s really not a powerful enough tool on its own to diagnose,” she says. “In addition to testing, patient history also plays an important role in diagnosis.

“If you are concerned that you’re having a heart attack, it’s important to advocate for yourself if you’re at the hospital and something does not feel right,” Feinberg advises. “Ask the attending doctor questions about what they think is going on and why. If you have concerns about treatment and you are not at a hospital that you feel comfortable with, you can ask for a transfer. If you’ve been discharged and have ongoing symptoms, are not improving or just don’t feel right, get a second opinion or check in with your physician right away.”

Heart Attack Prevention

Older women, particularly those already diagnosed with heart disease, can take measures to reduce their risk for heart attacks and other cardiac issues.

  • Schedule a regular physical with your physician.
  • Know your numbers for blood pressure, cholesterol and blood sugar, and follow your doctor’s advice if medication is needed.
  • Stay physically active.
  • Follow a healthy diet.
  • Avoid smoking or putting on excess weight.

You can also learn more about your risk (if you do not already have heart disease or diabetes) with the American Heart Association’s Heart Attack Risk Calculator.

Taking time for proactive healthcare, being alert to symptoms, and responding quickly when symptoms emerge are all important ways that women can take care of themselves. Since women are frequently the caretakers and health care managers for their families, they shouldn’t hesitate to use their expertise when it comes to themselves!

Above content provided by the CardioVascular Institute at Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Posted May 2015

Comments