Heart Attack Facts Every Midlife Woman Needs to Know

I’ve told this story half a handful of times on the Hit Play Not Pause podcast, but it bears repeating. Several years ago, my mom was having nearly debilitating, radiating shoulder, neck, and back pain, along with random panic attacks and general fatigue. She went to her doctor, who decided my mom was just stressed out and gave her “nerve pills.”

 Those meds tranquilized my mother, but didn’t prevent her from having a full-blown, massive heart attack months later. Thankfully, my dad was there to call 911 and open-heart surgery saved her life.

I’m still angry that the medical system failed her so terribly. She was 70 years old, completely sedentary, smoked cigarettes for the better part of her life, is not lean (which I mention because the medical system is so otherwise quick to evaluate patients by BMI), has a history of high cholesterol, and only touches a fruit or vegetable to push it off her plate. And you still don’t suspect heart disease???

Imagine how many younger, otherwise healthier women the medical system mismanages when it comes to heart disease? Well, you don’t have to imagine, a report this month from the American College of Cardiology will tell you.

Among younger adults, ages 18 to 55, visiting the emergency department for chest pain, compared with men of similar age, women were triaged less urgently, waited longer to be seen, and were less likely to undergo basic tests or be hospitalized or admitted for observation to diagnose a heart attack, according to new research presented at the ACC’s 70th Annual Scientific Session.

This was the first study to examine emergency room management of chest pain for younger adults specifically. To study this situation, the researchers examined data from the National Hospital Ambulatory Medical Care Survey from 2014 to 2018, which represented an estimated 29 million emergency department visits for chest pain in the U.S. among adults aged 18 to 55. Women comprised nearly 57 percent of those visits.

Researchers found that women reporting chest pain were equally likely to arrive at the hospital by ambulance, but then were significantly less likely than men to be triaged as emergent (meaning they cannot safely wait around until a space in the clinical area becomes available). On average, women waited about 11 minutes longer to be evaluated by a clinician. Women were also significantly less likely to undergo an electrocardiogram (EKG), the standard initial test used to diagnose a heart attack, or to receive cardiac monitoring or be seen by a consultant, such as a cardiologist.

 That’s a big freakin’ deal because every minute matters in the cardiac chain of survival. Medical guidelines recommend that all patients with possible heart attack symptoms receive an EKG within 10 minutes of arrival in the emergency department to minimize the time to treatment.

Heart disease is the leading cause of death in women—something far too many of us still don’t recognize. According to data from the CDC, though we are more aware of the risk of heart disease in women today, only about half (56%) of women recognize that heart disease is their number 1 cause of death. About one-third of women hospitalized for a heart attack over the past 20 years were under 55, a proportion that has grown in recent years.

Active women are not immune. Even if you’re a triathlete, ultra runner, or can deadlift twice your bodyweight, you may still have high blood pressure, risky lipid levels, and cardiovascular disease.

Menopause also raises our risk. As our sex hormones fluctuate and decline, we experience changes in lipid and lipoprotein levels (e.g. cholesterol and triglycerides), body fat distribution (a.k.a. the migration of fat to our abdominal area), as well as sleep disturbances, increases in anxiety and depression, increased insulin resistance and blood glucose levels and other metabolic risk factors that are largely independent of aging alone.

A report published in the November 2020 issue of Circulation made a strong case for why the menopausal transition should be considered an independent risk factor for heart disease.

Despite this, women still do not receive the same preventative care as men. In a meta-analysis of 43 studies including 2,264,000 men and women worldwide ages 56 to 71 that was published in the Journal of the American Heart Association, researchers found that women were significantly less likely to be prescribed aspirin, statins (for cholesterol management), and ACE inhibitors (a type of blood pressure medicine) compared to men.

 The take home message here is that it is imperative to a) understand that you are not immune to heart disease and b) advocate for yourself if you suspect something is wrong.

Tune into your body during training. If your heart is suddenly zooming along at 200 beats per minute during your warm up, that’s a sign to get checked out. If you’re working out as you always do and you are sucking wind for no good reason, that’s a sign to get checked out. If you’re nearly blacking out while working out, get checked pronto.

Don’t blow off heart palpitations. Menopause can sometimes cause symptoms that “mimic” more serious heart disease, specifically heart palpitations and irregular heartbeats known as arrhythmia. It can feel like a hummingbird fluttering in your chest, your heart flopping, racing, or banging in your chest, or like your heart is skipping a beat. These palpitations are the result of estrogen decline, which leads to an overstimulation of your heart. Though they’re usually harmless, palpitations and irregular heartbeats shouldn’t be ignored. Make an appointment with your doctor to rule out anything serious.

Critically, if you experience one or more symptoms of a heart attack, call 911. That’s a medical emergency. Every minute matters when it comes to getting life saving care. Classic symptoms include:

• Chest pain: Also described as tightness, crushing (like someone is sitting on your chest), pressure, squeezing, aching.
• Radiating pain or discomfort: Be alert to any pain or discomfort in your upper body, especially if it is radiating through your shoulders or jaw, neck and arms. Some people also experience back pain.
• Sweating: Breaking out in a cold sweat (as opposed to a hot flash), where you start perspiring for seemingly no reason is another classic heart attack alarm.

 Some people, especially women, experience non-classic symptoms, which can show up well before a heart attack. In a study of 500 women who’d had a heart attack published in Circulation, researchers found that 71 percent had experienced unusual fatigue, 48 percent had sleep disturbances, and 42 percent had shortness of breath more than one-month prior. Only 30 percent had chest discomfort. These non-classic symptoms include:

1.  Shortness of breath: If you find yourself breathless doing everyday tasks like taking the stairs or carrying groceries, don’t blow it off. That’s a serious warning sign.
2. Weakness: Unexplained weakness in your arms or legs can be a symptom of blockages that lead to heart attack. If you suddenly feel inexplicably weak or shaky, don’t ignore it.
3. Nausea or vomiting: Pain or pressure in your stomach and/or nausea and vomiting is another overlooked symptom of heart attack. 
4. Dizziness or lightheadedness: Unexplained dizziness is another sign, again because of lack of blood flow.
5. Unexplained fatigue: Feeling overwhelmingly fatigued from daily activity like making the bed is a big red flag.