Heart Attack in a Woman: Recognize the Silent Symptoms & Call 911

What is heart attack in a woman?

A heart attack happens when the heart does not receive enough oxygenated blood to meet its demand, resulting in the death of heart tissue. This can be caused by a decreased supply of oxygenated blood or too high of a demand.

Symptoms include chest pain or pressure that is dull, likely located in the center of the chest beneath the breastbone. This pain will often get worse with exertion, but can even be worsened by rest, sleep, or mental stress. Some women do not experience any chest pain at all, and may simply experience sweating, shortness of breath or nausea.

If you are experiencing symptoms that lead you to believe you are having a heart attack, you should seek emergency treatment. Treatments will likely involve oxygen, pain medications, medications to improve outcomes after the attack, placement of a stent, medication to break up any clots, as well as surgery.

You should call 911.

Heart attack in a woman symptoms

In most cases, heart attacks cause similar symptoms in women and men. However, women are more likely to have symptoms that are different from the typical chest pain associated with heart attacks.

Main symptoms

Similar to men, women experiencing a heart attack often develop chest pain or pressure. However, women are more likely to develop heart failure and experience symptoms such as shortness of breath and swelling of the abdomen or legs (edema). Details include:

• Chest pain or pressure that is dull
• Tightness in the center of the chest: Often felt beneath the breastbone, this tightness may spread to the neck or arms.
• Chest pain that is worse with exertion: Just like in men, in women, the chest pain is likely to get worse with exertion and better with rest.
• Chest pain that is triggered by rest, sleep, or mental stress: Women who are experiencing a heart attack are more likely to experience chest pain that is triggered by these factors.
• An absence of chest pain: Twenty percent to 40 percent of women who are experiencing a heart attack may not experience chest pain.
• Symptoms of heart failure: This is when the heart stops pumping blood effectively, causing fluid to build up in the lungs, leading to shortness of breath or swelling in the abdomen or legs (edema).

Other symptoms

Some women experiencing a heart attack may also experience the following as their only symptom, without any chest pain:

• Sweating
• Nausea or vomiting
• Weakness
• Lightheadedness
• Passing out

Causes of a heart attack in a woman

Heart attacks can be caused by either a decreased supply of oxygenated blood to the heart, which is commonly seen with the rupture of plaque in a blood vessel supplying the heart, or the heart increasing its demand for oxygen, which can be seen during exertion or abnormally fast heart rhythms.

Most risk factors are the same for women and men, although they may be stronger risk factors in women. These shared risk factors include:

• Older age: This is an important risk factor for developing a heart attack in both men and women.
• Family history of heart disease: This is especially likely if a first-degree relative has premature heart disease (before age 55 in men and before age 65 in women). This is seen more commonly in women than in men.
• High blood pressure (hypertension): This is a risk factor for developing a heart attack and is a stronger risk factor for women than for men.
• Abnormal blood lipid levels (hyperlipidemia): In women, having low levels of high-density lipoprotein cholesterol — commonly referred to as the "good cholesterol" — is associated with an increased risk of developing a heart attack.
• Diabetes: This is a risk factor and is a stronger risk factor for women than for men.
• Smoking: This is a strong risk factor in both men and women.

Risk factors unique to women

In addition, some factors increase the risk of developing a heart attack that are unique to women. These include:

• Starting menstruation at an earlier age: Menstruating at 10 years of age or younger have a higher risk of developing a heart attack. The reason for this is unclear but may have to do with longer exposure to estrogen.
• Taking oral contraceptives: This is associated with a slightly increased risk of developing a heart attack. However, because heart attacks are normally rare among women of reproductive age, the risk of developing a heart attack while on oral contraceptives is low.
• Going through menopause: It is unclear if going through menopause (and the change in hormones) increases the risk of developing a heart attack or is just associated with an increased risk of developing a heart attack due to older age.

Treatment options and prevention

Women having a heart attack are treated with the same approach as men having a heart attack. These including medications and supportive care to relieve symptoms as well as a procedure or surgery to restore blood flow to the heart. Specific treatments are usually used sequentially in this order, including oxygen, pain medication, other medications to address blood clots and improve outcomes, and procedures.

Oxygen

Women who are experiencing a heart attack who are not getting enough oxygen to their bodies will be given supplemental oxygen delivered through a tube placed under the nose or through a mask.

Pain medication

Women who are experiencing a heart attack will be given medications to relieve their pain. They may first be given up to three doses of nitroglycerin (Nitrostat), which is dissolved under the tongue. If the pain is still not relieved, they may be given morphine intravenously.

Medications to improve outcomes of the attack

Women who are experiencing a heart attack will receive medications shown to improve the outcomes. Several options may include aspirin, clopidogrel (Plavix), ticagrelor (Brilinta), heparin, enoxaparin (Lovenox), fondaparinux (Arixtra), metoprolol (Lopressor), atenolol (Tenormin), atorvastatin (Lipitor), and rosuvastatin (Crestor).

Percutaneous coronary intervention

Women who are experiencing a heart attack may benefit from a procedure called percutaneous coronary intervention (PCI) if they can receive it in a timely manner. This procedure involves threading a catheter through a blood vessel to the heart to open the blocked blood vessel, leaving a stent that keeps the blood vessel open.

Medication to break up the clot

Women who are experiencing a heart attack who cannot undergo percutaneous coronary intervention may instead benefit from medication to break up the blood clot. This can be done with medications such as alteplase (Activase) or reteplase (Retavase).

Surgery to restore blood flow to the heart

In uncommon cases, women experiencing a heart attack may need to undergo open heart surgery to restore blood flow to the heart. In this surgery, blood vessels from elsewhere in the body will be used to bypass the blocked blood vessels in the heart and restore blood flow.

When to seek further consultation

If you develop any symptoms of a heart attack, such as chest pain or pressure, shortness of breath, nausea or vomiting, or lightheadedness, you should go to the emergency room or call an ambulance. A heart attack is a dangerous condition that needs to be treated emergently. The physician can order tests to determine if you are experiencing a heart attack and then offer the appropriate treatment.