Heart attacks not always easy to diagnose in women
Dear Doctor:
A month ago, our 69-year-old mother became nauseated and had pain in her jaw. Then she got so weak that my brother made her go to the ER. It turned out she’d had a heart attack. She never had chest pain, so she had no idea anything bad was going on. Is that common?
Dear Reader: The scenario you’ve described could happen to at least half of the world’s population -- women. The symptoms of a heart attack in women can be very different from those in men, often with little or no overlap. A woman has a 50% higher chance of her heart attack being misdiagnosed than a man, according to the Centers for Disease Control and Prevention. Many women having a heart attack won’t get appropriate or timely treatment.
Heart attack is the term used to describe what happens when delivery of oxygen and nutrients to the heart is interrupted. This occurs when something stops or slows the flow of blood through a crucial network of vessels that surround the heart, known as coronary arteries. The blockage, which can be caused by a blood clot, plaque or a narrowing of the vessels, prevents blood that is rich in oxygen and nutrients from reaching the heart tissues. Without this blood flow, the heart muscles begin to die.
Recent research into heart disease in women has found that female patients’ major arteries are often clear of plaque, but that the smaller coronary blood vessels are adversely affected. This also results in a decrease or stoppage of blood flow -- and therefore oxygen and nutrients -- to the heart. Women with this type of coronary blockage will have seemingly normal angiograms, which adds to the diagnostic challenges.
With quick treatment after a heart attack, permanent damage can be limited. However, fewer women than men survive a first heart attack, due in part to their symptoms not being recognized. Unlike men, who often have the so-called “Hollywood heart attack,” with pain or numbness in the left arm followed by sudden and sometimes crushing chest pain, heart attack symptoms in women are subtler. They include the nausea, jaw pain and exhaustion that your mother experienced; pressure in the chest that doesn’t read as pain; indigestion or heartburn; pain in the throat, neck or back; vomiting; or shortness of breath. Women experiencing these symptoms should seek emergency medical care and state clearly that a heart attack is suspected.
Factors that increase heart attack risk for women -- and for men -- include smoking, high blood pressure, poor diet, being overweight, physical inactivity, diabetes and family history. To reduce risk, lifestyle changes are key. Eat more plant-based foods, limit animal fats, exercise, drink in moderation, maintain a healthy weight and don’t smoke. If possible, add some stress-reduction activities, such as meditation, yoga or hiking.
Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health.