In standard textbooks of cardiology, much space is devoted to a description of the symptoms that typically occur with heart disease. In most cases, these "typical" symptoms turn out to be a recitation of the symptoms as they are commonly experienced by men. And while cardiologists (relying on those textbooks) may think about the symptoms of heart disease in women as being "atypical," when you consider that more women are dying of heart disease today than men, it may be statistically more correct to think of men's symptoms as the ones that are "atypical."
If you are a woman who is experiencing symptoms that you think might be related to your heart, you need to see a doctor. Here are some of the ways in which the symptoms of heart disease experienced by women can differ from the symptoms experienced by men.
Angina Doesn't Necessarily Equal Chest Pain in WomenAngina is typically described as a pressure-like chest pain that may radiate to the jaw or shoulder, and in men that's usually accurate. But many women with angina will report a hot or burning sensation, or even tenderness to touch, that may be located in the back, shoulders, arms or jaw. And, often they have no actual chest discomfort at all.
Any good doctor will think of the possibility of angina whenever a patient (of either sex) describes any sort of fleeting discomfort located anywhere above the waist that occurs during strenuous activity. Doctors really shouldn't be thrown off by "atypical" descriptions.
However, because too many doctors persist in believing that coronary artery disease is relatively uncommon in women, they may write such symptoms off as mere musculoskeletal pain or gastrointestinal (or even less forgivably) emotional disturbances.
Angina With Normal Coronary Arteries Is More Common in Women
Furthermore, women are much more likely than men to experience angina when their coronary arteries appear completely "normal" during cardiac catheterization. These women are often told that their symptoms are due to a gastrointestinal disorder (or worse, that the symptoms are in their head), when in fact they have a significant cardiac problem.
Heart Attacks Are Different, Too
Heart attacks and acute coronary syndrome may also behave differently in women than in the typical male. Frequently, women having heart attacks will experience nausea, vomiting, indigestion, shortness of breath or simply sudden and extreme fatigue - but no chest pain. Unfortunately, it is easy for doctors to attribute such symptoms to something other than the heart. Women also are more likely than men to have "silent myocardial infarctions" - that is, heart attacks without any acute symptoms at all, which are diagnosed only retrospectively when subsequent cardiac symptoms occur.
Women Tend to Minimize Their SymptomsStudies now indicate that women tend to complain less about their cardiac symptoms than men, so they may fail to alert their doctors to symptoms that really should not be ignored. Why they tend to do this is pure speculation. Perhaps women are more innately stoic than men, or perhaps they are tired of being told by doctors they're just anxious. Either way, it is important that you tell your doctor about ANY new or disturbing symptom that even remotely might be related to your heart.
When Should Women Seek Medical Help For Possible Cardiac Symptoms?Given that cardiac symptoms in women may not follow the textbook, how do you know when you should seek medical help for symptoms that MIGHT be related to your heart? The rule you should follow is really pretty simple - if you think it might be related to your heart, see a doctor. Here are some specific guidelines that might help:
Get medical help if you might be having angina
Go to your doctor or to the emergency room right away if you have any of the following symptoms:
- Episodes of pain, pressure, burning or squeezing in the chest, jaw, shoulders, back, or arms, lasting up to 5 to 10 minutes
- Unexplained episodes of shortness of breath lasting up to 5 to 10 minutes
- Episodes of palpitations with lightheadedness or dizziness
Call 911 immediately if you experience any of these symptoms:
- Pain, pressure, burning or squeezing in the chest, jaw, shoulders, back, or arms, that lasts more than 5 to 10 minutes
- Unexplained shortness of breath lasting more than 5 to 10 minutes
- Sudden severe nausea, vomiting or indigestion
- Sudden sweating for no reason
- Sudden unexplained extreme fatigue
- Loss of consciousness or fainting
- Sudden, unexplained, panicky feeling of doom
Mosca, L, Manson, JE, Sutherland, SE, et al. Cardiovascular disease in women: a statement for healthcare professionals from the American Heart Association. Writing Group. Circulation 1997; 96:2468.
Lehmann, JB, Wehner, PS, Lehmann, CU, Savory, LM. Gender bias in the evaluation of chest pain in the emergency department. Am J Cardiol 1996; 77:641.