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Dossier: Healthy heart

Heart attacks: symptoms in women

Women march to a different beat – at least when it comes to their health. Although women are biologically better protected against heart attacks until menopause, they're more likely to die from one than men. This is often because the symptoms are misinterpreted.

Text: Katharina Rilling; foto: Gantas Vaičiulėnas / Unsplash

A classic heart attack in men is signalled by chest pain, an inability to lift the left arm and shortness of breath.  However, the symptoms of a heart attack in women are less well known. The fact is, heart attacks are still considered to be a male condition. According to cardiologist Dr Belinda Nazan Walpoth, who heads the special “Woman and Heart” surgery at the Inselspital in Bern, this thinking is outdated: “Heart disease is roughly as common in women as in men. In fact, heart attacks are actually the main cause of death in our part of the world – and not breast cancer, as is often thought to be the case.”

She’s noticed that it doesn't even occur to women that they might have heart disease. The men in their life, and even some doctors, aren’t aware of the symptoms. She gives a classic example of a woman in her fifties, slightly overweight and with elevated cholesterol levels: “She phoned her family doctor because she was suffering from fatigue and stomach pains. It was a time of year when colds were widespread. The woman told her doctor that she couldn’t lift her arms because she was so tired. She was advised on the phone to rest. She didn’t have a temperature, so was told to get back in touch if her condition worsened. Two hours later, the woman turned up at the doctor’s practice because she was so worried about how fatigued she was. And it turns out she’d had a heart attack! She was sent straight to hospital, where the blocked blood vessel was opened. I saw her three months later for a follow-up check. She told me she'd never expected to have a heart attack.”'


Heart attack in women: the symptoms 

The problem is that the warning signs are often difficult to identify in women. And the first hours are critical for anyone having a heart attack. “You should open up the closed vessel very quickly to prevent tissue loss,” says the heart specialist.

If women don’t have the “classic” signs, such as a chest pain or radiating pain in the left arm, they often play down or misinterpret their symptoms. Caution is advised when a woman experiences sudden fatigue, problems sleeping, shortness of breath and digestive problems, numbness in the arms and/or pain in the back or legs. These symptoms may initially sound harmless, but they can be a warning sign of a heart attack days or weeks in advance. Too often they are put down to a cold, muscle pain, the menopause or stress. But you’re unlikely to go to the doctor due to tiredness and stomach pains. “Women with abdominal pain, sudden shortness of breath and fatigue are better advised to go to hospital once too often, especially if they have diabetes or metabolic syndrome, i.e. high cholesterol levels, if they are overweight, have high blood pressure or borderline sugar levels,” says Dr Walpoth.

Women usually present with different symptoms than men when they have a heart attack:

  • Shortness of breath
  • Unexplained nausea and vomiting
  • Pressure in the chest, back or (upper) belly
  • Pain through neck and jaw
  • Tiredness

However, according to the Swiss Heart Foundation, women can also suffer the “classic” symptoms:

  • Severe pressure and tight, constricting or burning pain in the chest (lasting longer than 15 minutes), often associated with shortness of breath and fear of death
  • Sometimes (!) radiation of the pain throughout the chest, through to both shoulders, arms, neck, lower jaw or upper abdomen
  • Possible accompanying symptoms are a pale complexion, nausea, weakness, sweating, difficulty breathing and irregular pulse
  • The pain is independent of movement and breathing and doesn’t go even after taking the nitroglycerin.

Risk factors for heart disease in women 

On average, women are ten years older than men when they suffer a heart attack. This goes someway to explaining the higher mortality rate for women after a heart attack even with the same treatment: With increasing age, the risk of the disease becoming fatal increases. While men are more likely to have a heart attack from the age of 50, the risk of cardiovascular disease for women increases around ten years later. It's believed that female hormones provide biological protection that starts to wear off after menopause. “I advise women to have their risk profile assessed by their family doctor at the very latest once the menupause sets in. Cholesterol? Blood sugar? Blood pressure? Weight? Nicotine? Family history?. In fact, ideally they should go even earlier. If you belong to a risk group and don’t feel well, you should get checked out by a cardiologist," says Walpoth. 

The typical risk factors are the same for men and women: High blood pressure, elevated blood lipid levels, stress, obesity, diabetes and smoking are all harmful to the heart. However, many factors have a bigger impact on the female body.

For example, the risk of heart disease is much higher in women with diabetes than in men. And women’s hearts seems to react worse to cigarette smoke, with the risk of a heart attack 25% higher for women who smoke than men. And if a woman who smokes also takes the pill, this has an even greater negative effect on heart health, as blood clots can form. Permanent stress and depression are also more damaging to women’s heart health than men’s. The same is also true of even small amounts of alcohol.

Women also have a host of other risk factors, such as unusually early menstruation (under the age of 10), early menopause and pregnancy complications such as pre-eclampsia and eclampsia. Dr Walpoth also says: “Women today often struggle to juggle family and work, and we know that stress is a big risk factor for women.”

Prevention and treatment: what’s good for women’s hearts?

As with everything, a healthy lifestyle is also good for your heart. Ideally, you should eat a balanced diet, get regular exercise, try to avoid stress, maintain an ideal weight, not smoke and not drink too much alcohol. It’s also a good idea to get your blood pressure, cholesterol and blood sugar checked regularly. “My top tip is to take preventive measures against risk factors, have preventive medical check-ups and – if medication is necessary – to make sure you take it.”

For a long time, women were given the same treatment as small men. However, it’s not only the lower bodyweight that means women respond differently than man to many medicines. Their blood vessels are also different. "Gender medicine enables us to address and raise awareness of women-specific aspects in the prevention, diagnosis and treatment of cardiovascular diseases,” says Dr Walpoth. “The awareness that women’s hearts beat differently and need a different treatment is vital.”