World Heart Day: Heart Attack Symptoms Women Ignore

Cardiologist Dr Vivek Mahajan explains the heart attack symptoms women often mistake for acidity, stress, menopause or fatigue and when to seek help.

When you think of a heart attack, the image that probably comes to mind is sudden, crushing chest pain, breathlessness and sweating.

But for some women, the warning signs may be far less dramatic.

Unexplained fatigue. Sudden weakness. A headache. Back, neck or throat pain. Stomach discomfort. Indigestion. Even diarrhoea.

These symptoms can easily be dismissed as acidity, stress, exhaustion, menopauseor simply a bad day. And that can be dangerous.

In a conversation with Rishika Shah/Rediff, Dr Vivek Mahajan, interventional cardiologist and electrophysiologist at Fortis Hospital, explains why women need to pay attention to both the classic and less obvious symptoms of a heart attack.

Dr Mahajan has a postgraduate degree in interventional cardiology from the Post Graduate Institute of Medical Education and Research, Chandigarh, and a master's degree in medicine from the All India Institute of Medical Sciences, New Delhi.

It isn't always crushing chest pain

The symptoms most people associate with a heart attack still matter. Chest heaviness or tightness, breathlessness and sweating can occur in women just as they do in men.

But Dr Mahajan says women may also experience general weakness, unusual fatigue and non-specific symptoms.

These can include headaches, abdominal symptoms, stomach discomfort, back pain, neck or throat pain and, in some cases, diarrhoea.

"Women may experience more of a general weakness," Dr Mahajan says. "They may experience fatigue. They may experience non-specific symptoms."

The key word is 'unexplained'.

If a woman suddenly starts experiencing symptoms that she has never experienced before, particularly if they occur with exertion or are accompanied by other warning signs, they should not simply be written off.

When 'acidity' may need a second look

Indigestion and acidity are among the easiest symptoms to dismiss. After all, most people experience them from time to time. Context, however, matters, says Dr Mahajan.

For example, if a woman usually gets occasional acidity but suddenly develops severe or unusual acidity along with sweating, weakness or breathlessness, she should not automatically assume it is a digestive problem.

Similarly, if symptoms appear while walking or exercising rather than at rest, they deserve attention.

"You have to look at everything in totality, not just at one symptom," he explains. The warning becomes stronger when several symptoms occur together.

Indigestion accompanied by sweating, breathlessness, extreme weakness, giddiness or a feeling of almost blacking out should not simply be treated with an acidity tablet and ignored.

And if the usual treatment does not relieve an unusual symptom, that is another reason to seek medical attention.

What does unusual fatigue actually look like?

Feeling tired is extremely common. The more concerning pattern is new, unexplained fatigue, particularly when it appears during activities that were previously manageable.

Dr Mahajan gives the example of someone who has never experienced a particular symptom before and suddenly develops significant acidity or fatigue along with sweating.

Similarly, if a woman finds herself becoming unusually tired or breathless while walking despite otherwise normal blood tests, it warrants further evaluation.

The important clue is a change from her usual baseline.

If you could comfortably walk a certain distance before but suddenly become unusually exhausted or breathless doing the same activity, don't automatically assume it is simply ageing, stress or lack of sleep.

Women can have 'silent' heart attacks

Another reason women need to pay attention to seemingly minor symptoms is that heart attacks do not always announce themselves with dramatic pain.

Dr Mahajan says silent heart attacks may be more common in women, although it is difficult to give an exact percentage because, by definition, they may go unnoticed.

Some patients only discover during later cardiac investigations that they have previously suffered a heart attack without recognising the symptoms at the time.

Such women may have experienced symptoms such as weakness, fatigue, headache or digestive complaints rather than the classic chest pain.

That is why unexplained symptoms should not automatically be dismissed.

Don't blame everything on menopause

Women may also be more likely to attribute new symptoms to hormonal changes or aging.

Dr Mahajan points out that women are often perceived as being relatively protected against heart disease before menopause but this protection changes as oestrogen levels decline.

After menopause, cardiovascular risk rises significantly.

This can create another problem -- symptoms such as breathlessness, fatigue or general weakness may be attributed to menopause rather than investigated as potential cardiac symptoms.

There can also be a diagnostic bias in the opposite direction.

Dr Mahajan says some women with genuine cardiac symptoms may have their complaints attributed to psychological causes while others without heart disease may undergo unnecessary cardiac investigations because their symptoms are interpreted incorrectly.

His approach is not to assume either way.

"If the symptoms are not going with an anti-anxiety tablet, I do not label them further as an anxiety issue. I go for cardiac evaluation for such patients," he explains.

Younger women aren't completely protected

Heart attacks are less common in younger women than in older women but young age does not make someone immune.

Certain women may have risk factors that increase their vulnerability.

Dr Mahajan points to familial hypercholesterolemia and other lipid disorders as examples of conditions that can run in families and increase cardiovascular risk even at a younger age.

He also mentions oral contraceptive pill use as a potential risk factor for thrombosis or clotting in certain women.

Another important condition is spontaneous coronary artery dissection (SCAD), in which a tear develops in the wall of a coronary artery. Dr Mahajan notes that hormonal changes around pregnancy can be associated with this condition and that it can cause heart attacks in women.

So while heart attacks may be less frequent among younger women, they are certainly possible.

Pregnancy can affect cardiovascular risk too

Pregnancy itself places considerable demands on the cardiovascular system.

Dr Mahajan also highlights pregnancy-related hypertension as a factor that can affect a woman's future cardiovascular health.

Conditions such as high blood pressure and diabetes need to be taken seriously, particularly as a woman gets older and the protective effects associated with pre-menopausal oestrogen decline.

Other established cardiovascular risk factors, including high cholesterol, smoking and obesity, also matter.

The takeaway is simple -- being a woman does not cancel out the traditional risk factors for heart disease.

So when should you actually worry?

There is no single symptom that women should wait for before seeking help.

Instead, look for something unusual, unexplained or different from your normal pattern, particularly when several symptoms occur together.

Dr Mahajan says women should pay attention to symptoms such as:

• Chest heaviness, tightness or discomfort
• Breathlessness
• Excessive sweating
• Unusual or extreme fatigue
• Sudden weakness
• Giddiness or a feeling of almost blacking out
• Jaw, neck or throat pain
• Back pain
• Headache
• Unusual stomach or abdominal discomfort
• Indigestion or acidity that is unusual for you or does not improve with your usual treatment

The presence of one of these symptoms does not automatically mean a woman is having a heart attack. But a new, unexplained symptom, especially when it occurs with other warning signs or during exertion, should not be casually dismissed.

The biggest mistake? Assuming heart disease is a man's problem. Perhaps the most important message for women is that heart disease does not belong to one gender.

Women can have the classic symptoms. They can have less specific symptoms. They can have silent heart attacks. And their symptoms can sometimes be mistaken for digestive problems, anxiety, stress, exhaustion or menopause.

That makes awareness especially important.

As Dr Mahajan explains, women need to know that the classical symptoms of heart disease are still relevant to them. But when something unusual happens, they should also recognise that a heart attack can sometimes present in less obvious ways.

On World Heart Day, the message is worth repeating: Don't wait for dramatic chest pain before taking your heart seriously.

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