Most people like to think they would know a heart attack when they feel it: severe chest pains, dizziness and difficulty breathing. But new research shows that, for women, the signs of a heart attack may be much more subtle. In fact, a woman might not know she is suffering heart problems at all.

According to a study by the Maryland-based National Institute of Health, women are far less likely to experience the symptoms commonly associated with a heart attack. In a survey of 515 female heart patients, fewer than 30% reported having chest pain or discomfort prior to their attacks, and 43%
said they didn’t feel chest pain during the attack, either. The most commonly reported symptoms prior to the attack were unusual fatigue, sleep disturbance and indigestion; during the attack, they reported shortness of breath, weakness and fatigue. The trouble is that the symptoms point to any number of minor illnesses or health issues — not least of all, a heart attack.

However, atypical symptoms are just a part of the problem in detecting heart attacks among women, says Dr. Beth Abramson, a Toronto cardiologist and Heart and Stroke Foundation spokesperson. For reasons not entirely understood, menopause delays the development of heart disease in women by about seven to 10 years. As a result, women typically remain healthy when men their age first begin to suffer from heart disease and are, therefore, less likely to think they will be affected by heart problems at all. In fact, they can develop similar problems but later in life.

“Women still tend not to think heart disease can happen to them,” Abramson says. “But women are living like men — and dying like men.” In fact, coronary disease is the No. 1 killer among Canadian women, accounting for 18,507 deaths in 2002 (the most recent figures available), more deaths than all forms of cancer combined.

Clinically known as an “acute myocardial infarction,” a heart attack occurs when the blood and oxygen supply to the heart is severely reduced or stopped, usually because one or more of the coronary arteries sending blood to the heart muscle is blocked by a build-up of plaque (mostly cholesterol). The plaque can eventually create a blood clot that blocks the artery, causing injury to the heart muscle.

Without treatment, heart attack sufferers run the risk of severe heart muscle damage and death. A recent study of 20,000 heart attack patients found that those who do not experience typical symptoms, such as severe chest pain, are three times more likely to die from the attack than those who do. The study, published by the American College of Chest Physicians, suggests that patients who don’t feel pain are unlikely to receive appropriate treatment until a series of tests reveal the severity of their condition.

Atypical symptoms can occur in both men and women but, Abramson says, heaviness in the chest is still the most commonly reported sign of a heart attack, often followed by discomfort in the throat and jaw, shoulderblade pain, nausea and shortness of breath. Symptoms that come on with exercise and go away with rest should be evaluated by a doctor, she says.

Generally, the risk of heart attack can be summed up by what Abramson calls “bad luck, bad living and bad genes.” More specifically, diabetes, smoking, high blood pressure, high cholesterol and a family history of coronary heart disease increase the risk. Stress, on the other hand, is very weakly linked to coronary heart disease. “It’s more a matter of how we deal with stress than the stress per se,” Abramson says.
Bad reactions to stress, such as smoking and overeating, will increase the risk of heart disease more than stress itself.

The good news is that heart attacks are preventable. “All women need to be aware that this is a leading health threat and they need to start taking on heart-healthy behaviours,” Abramson says. “You’re never too young or too old to start.”

Heart-healthy behaviour includes not smoking, cutting back on fat and calories and monitoring weight gain, particularly around the waist. Weight gain in the waist area raises the risk of high blood pressure, high cholesterol and diabetes, Abramson says. Regular exercise also goes a long way in preventing heart disease.