The Silent Heart Attack: Cardiac Arrest in Women

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Heart attack symptoms can differ between men and women – but what are these specific set of symptoms and why does this difference exist asks medical researcher and female health advocate, Dr. Emily Handley.

When a person has a heart attack on TV, you may envision the stereotypical clutching of the chest, a sudden gasp of pain – and you probably picture the person experiencing this as a man. Men are more likely to be experience a heart attack, with 70-89% of all sudden heart attacks being experienced by men. Yet women have a 20% higher chance of developing complications after a heart attack, and heart disease kills three times as many women as breast cancer. Both of these issues have been linked to the sex differences in heart attack symptoms between men and women – but what are these specific set of symptoms and why does this difference exist?

What is a heart attack? 

A myocardial infarction – known more commonly as a heart attack – is when blood flow to the coronary artery is stopped or impeded. This damages the heart muscle, and the more time that passes without restored blood flow, the more the muscle is injured. Heart attacks occur primarily due to coronary artery disease, with a severe spasm or contraction of the coronary artery being a less common cause. But what triggers these changes to our heart’s function? Though men and women both share common risk factors for coronary artery disease and subsequent heart attack, there are other factors that play a larger role in the development of heart attack in women.

What are the risk factors? 

Heart attack Risk factors PHH

The traditional risk factors for coronary artery disease are the triad of high cholesterol, high blood pressure and obesity – all linked to the reduced ability of the arteries to pump blood to and from the heart. Less well-known, women have to take into account specific risk factors that increase the risk of heart disease leading to a heart attack.

Women with diabetes or who smoke regularly are much more likely to have a heart attack than their male counterparts. Diabetes can change how women actually feel pain, greatly increasing the risk of a silent or non-symptomatic heart attack.

Depression and stress can also increase the risk of heart attack in women. Emotional stress affects women’s hearts more, and depression can make it difficult to maintain an active lifestyle – protective against heart issues. Inactivity is a major risk factor for disease, and combined with co-morbidities often found in women, can result in it being a greater risk factor for heart attack development.

Both pregnancy and menopause increase the risk of a heart attack, with sex hormones once more wreaking havoc. Menopausal women experience low estrogen levels, which in turn raises the risk of heart disease impacting smaller blood vessels. Pregnancy comes with the added complications of long-term high blood pressure and diabetes; both increasing the likelihood of heart disease.

Finally, both your own and your family history of certain diseases can predispose women to heart disease to a greater extent than men. A family history of early heart disease is a greater risk factor in women than men, whilst inflammatory diseases – known to affect more women than men – can also increase the likelihood of heart disease.

What are the symptoms in women? 

signs of heart attack in women PHH

Time is of the essence when someone suffers from a heart attack. The longer it takes for treatment to commence, the more damage the heart undergoes and the higher the chance of life-long complications, or even death. The symptoms of a heart attack in women are often subtle and not well known, meaning they may be easy to ignore.

Pain or tightness in the chest is a common feeling of a heart attack, which can be caused by blockages in the main arteries. But women tend to have blockages in the smaller arteries leaving the heart – this means chest discomfort may not be as noticeable in women, making it easier to dismiss.

Women can also experience a shortness of breath, where they can’t get enough air into their lungs. This can begin several weeks before a heart attack even occurs and may be at the same time as light-headedness or dizziness begins. This can manifest as a feeling of ‘fogginess’ or ‘not being with it’.

Sudden changes that occur in women and not in men also include nausea, sweating and vomiting. An overwhelming feeling of clamminess or queasiness can be a sign of an impending heart attack, especially when combined with sudden and unusual fatigue or weakness.

Finally, women can often feel pain in other parts of the body. This can also appear quite suddenly, located in the neck, jaw, upper back, torso, belly and limbs. A heart attack in women can even manifest as reflux or digestive problems.

A lack of understanding of women’s heart attack symptoms means that women have a higher rate of death in hospitals; are more likely to develop heart failure after leaving hospital; are seen less frequently by a cardiovascular specialist for their heart attack; and fewer women are prescribed appropriate medications, regardless of heart attack type or severity. In fact, one study from England and Wales found that more than 8,200 women could have survived their heart attack if given the same level of care as men. And the outcomes are even worse if you’re a woman under the age of 50 experiencing a heart attack; being less likely to undergo necessary invasive therapeutic procedures and almost two times more likely to die during the follow up period.

There is a continued need and an obligation to improve the outcomes of women during and after heart attack, with the first step being knowledge and awareness of symptoms. But what can women do to lower their risk of heart attack in the first place?

How can you prevent a heart attack?  

Like a broken record, the greatest commitment you need to make to yourself is to maintain a healthy lifestyle. A balanced diet is critical for a healthy heart and should in particular include low levels of all the good stuff – low levels of fats, salts and sugars. A heart healthy diet should instead feature healthy fats in fish, nuts, avocado and olive oil; a bulk of fruit and vegetables; and plenty of fibrous wholegrain foods.

Another classic? The need to exercise regularly. Exercise is critical for heart health and goes hand in hand with maintaining a healthy weight. If it’s been some time since you exercised last it can be overwhelming to get back into the swing of things. Don’t let that get in the way – start small! Walking for 30 minutes, choosing to take the stairs, or even signing up to a casual dance class are all great ways to make exercise enjoyable and less stressful.

Finally, two of the most important factors of a healthy lifestyle are quitting smoking and reducing alcohol intake. Smoking in particular is one of the most frequently linked risk factors of cardiovascular diseases leading to heart attack.

Life after a heart attack 

After a heart attack, the heart muscle is often damaged; the steps taken to prevent heart attack can also be implemented in strengthening the heart again during recovery. Making a plan with your GP that suits you, your needs and your lifestyle is critical for your path to a true recovery and making changes that become lifelong habits. Cardiac rehabilitation is a key program for heart attack recovery, particularly when treatment requires invasive surgery or medical care. This program includes increasingly intensive physical activity; education around healthy eating, medication usage and quitting smoking; and counselling to help relieve stress, improve mental health or be referred to other professionals.

It’s fair to say that life will not be the same after a heart attack: there will be new medications and therapeutic interventions, along with new diet and exercise regimens. But these can only lead to better outcomes for your overall health and quality of life. Knowing the signs of a silent heart attack is crucial for receiving the best care in the necessary time. Even better? Sharing this awareness with your friends and family can save your life.

Disclaimer: This article provides general information only, and does not constitute health or medical advice. If you have any concerns regarding your health, seek immediate medical attention.