Spotlight On: Signs of a Heart Attack in Women

It’s an alarming statistic: “Two-thirds of women under 50 who die of coronary artery disease never knew they had it,” says Angela Taylor, M.D., a University of Virginia Health System cardiologist and co-director of UVA’s Club Red Clinic dedicated to women’s heart health. As a doctor and a researcher, she’s on a mission to uncover why this is—and do something about it. Read on to learn more about the subtle signs to watch for. 

Q. What are the signs of a heart attack?

A. Women need to be especially alert to what are sometimes subtle signs of an impending heart attack. A new study shows that women who had heart attacks experienced symptoms a month before their heart attack. Reported in Circulation: Journal of the American Heart Association, these findings offer somewhat of a silver lining: if women notice these signs and act upon them, they could get treatment to keep from ever having a heart attack. The most common early symptoms reported were:

• unusual fatigue (70 percent of the women in the study)
• sleep disturbance (48 percent)
• shortness of breath (42 percent)
• indigestion (39 percent)
• anxiety (35 percent) 

Q. What about chest pain?

A. Interestingly, only 30 percent of the women reported chest discomfort before their heart attack. They described aching, tightness and pressure—but not chest pain. Even during a heart attack, chest pain is not a common symptom for women. Instead, shortness of breath and indigestion are more common. 

Q. Why is a blocked artery harder to detect in women than men?

A. Coronary artery disease (CAD) is the most common type of cardiovascular disease. Coronary arteries are the major blood vessels that supply our hearts with blood, oxygen and nutrients. CAD forms when these arteries become damaged—usually due to a buildup of plaque made of cholesterol and other fatty deposits.

Coronary artery disease is usually more difficult to detect in women because it develops differently compared to men. In women, it’s often more discreet. Women start in their 20s to develop coronary artery disease with stresses on their body like pregnancy and instead of developing distinct blockages in the arteries like men do, women lay cholesterol down the entire length of the artery. This doesn’t show up on common diagnostic tests but still has the ability to cause a heart attack.

Q. What is the best way to prevent heart disease and a heart attack?

A. The straightforward answer for every woman is to make lifestyle changes to halt the progression, and even reverse the damage, of heart disease. Move more, stop smoking, eat lots of fruits and vegetables and limit high-fat foods—these changes can significantly reduce a woman’s chances of having a heart attack or stroke. 

It’s also very important that women work closely with a healthcare professional to make sure her cholesterol, blood pressure and blood sugar levels stay within healthy ranges. Diabetes, for example, is as much of a cardiovascular condition as it is a blood sugar problem. Scientific evidence shows that diabetes damages the heart muscle and other research suggests that women are more likely than men to die from diabetes-associated heart failure. 

Q. What if lifestyle changes alone are not enough?

A. When lifestyle changes alone are not enough to significantly reduce risk factors for heart disease, medications can be highly effective, particularly when combined with changes in diet and exercise. New guidelines from the American Heart Association and other professional organizations strongly recommend that women at high-risk for cardiovascular disease, even those with low-density lipoprotein (LDL) cholesterol levels below 100 mg/dL, should take cholesterol-lowering drugs. These new guidelines were the result of recent studies that show a benefit for this group.

Recommendations for how to best treat cardiovascular disease, especially in women, are continually evolving as we learn more about this prevalent disease. This makes it all the more important that women check in with a cardiologist at least once a year to make sure she’s still on the right course of treatment.