What Are the Unique Signs and Symptoms of Heart Attacks in Women?

Do you know what the No. 1 cause of death in women is? It is heart disease. In fact, 1 in 3 women die from heart disease, beating out lung cancer and breast cancer.

According to the Centers for Disease Control, coronary artery disease is the most common type of heart disease in the United States. Coronary artery disease is damage to the heart's major blood vessels, limiting blood flow to the heart and potentially causing a heart attack.

Knowing the signs, symptoms and risks of a heart attack can help save your life. One question we all have is this: Are heart attacks the same in both women and men? The short answer to this question is “No.” Read on to learn more about heart attacks in women.

What is different about heart attacks in women?

While women can get significant blockages in the heart's arteries from plaque build-up like men, which can be a source of heart attack, they can also get heart attacks for other reasons.

Women tend to have smaller arteries and experience more “wear and tear” when the heart pumps. Menopause accelerates dysfunction of these small arteries around the heart, especially in women with diabetes. The term “microvascular dysfunction” describes this process, which can lead to plaque buildup. This can cause a “silent” heart attack along with symptoms of chest pain due to a blockage in the heart.

The arteries of a woman’s heart can also repeatedly spasm, similar to a muscle cramp, which leads to less blood flow. This phenomenon can occur by itself or with microvascular dysfunction, leading to another type of heart disease commonly seen in women: ischemia with nonobstructive coronary arteries disease.

Myocardial infarction with nonobstructive coronary artery is a recently recognized type of heart disease largely affecting women below the age of 55. It represents 6% to 15% of heart attacks in women and is five times more likely to occur in women than men. Women who do not have traditional risk factors of heart disease are also at risk. In myocardial infarction, the heart is repeatedly injured due to a lack of blood flow despite a lack of major blockages in the arteries. Additional testing, like a PET scan or MRI, may be needed to determine the best treatment.

Am I at risk for heart attack?

Well-known risks of heart attack include the following:

Tobacco use
Diabetes
High blood pressure
High cholesterol
Obesity
Menopause
Family history of heart disease
Lack of exercise
History of auto immune diseases (i.e., rheumatoid arthritis, systemic lupus erythematosus

However, there are lesser-known risk factors that are unique to women and can include history of:

Irregular menstrual cycles
Polycystic ovary syndrome (PCOS)
Pre-eclampsia or high blood pressure during pregnancy
Estrogen deficiency
Diabetes during pregnancy
Premature menopause

What are the signs of heart attack in women?

The most common heart attack symptom in women is chest pain. This can feel like pain, pressure, tightness or discomfort in the left or right side of the chest/breast area, shoulders, arms, neck, back, upper abdomen or jaw.

However, women are also likely to feel additional unique symptoms such as nausea, shortness of breath, lightheadedness, confusion and/or fatigue. Because most women do not recognize that these could be signs of a heart attack, they, unfortunately, get less timely medical care, which often leads to worse outcomes.

How is this tested?

First, your doctor will determine the best test(s) for you. This will consist of blood work, an electrocardiogram (a recording of the heart’s electrical activity) and a scan such as a CT scan, MRI or an echocardiogram (also known as an echo which is an ultrasound of the heart). A stress test may be needed. A stress test involves exercising, such as walking on a treadmill or peddling on a bike, to determine how your heart responds when it is working the hardest.

Further advanced testing consists of a cardiac positron emission tomography scan (PET), which not only identifies areas of potential blockages, but can measure the blood flow through your arteries and help further diagnose those with disease in the small vessels of the heart.

Invasive testing may also be considered such as an angiography, which involves passing a wire or catheter to the arteries of the heart from your groin or wrist and shooting a dye into the cardiac vessels to identify larger blockages. For some women, an acetylcholine challenge may be performed. Acetylcholine is a drug that normally dilates the small vessels of the heart. This test can help identify those with microvascular or endothelial dysfunction, which is more common in women.

If you are pregnant, breast feeding or planning to get pregnant, your doctor will order the safest imaging study to avoid or minimize the dose of radiation to yourself and your baby. Alternative options include ultrasound of the heart (echocardiography) or MRI of the heart without contrast.

What is the treatment?

The good news is every woman is different! Medications and lifestyle changes are the cornerstones in heart disease management. However, depending on your heart disease type, you may need further invasive procedures and/or surgery.

Of note, pregnant women with heart disease are at risk for serious complications with their heart; approximately half of these are preventable, which is why you must meet with a medical professional.

How can I prevent this?

A healthcare professional guides each patient in making healthy lifestyle changes to help prevent or slow the progression of heart disease. Depending on your unique needs, recommendations may include:

Blood pressure management through nutrition, exercise and/or medication
Cholesterol management through nutrition, supplements and/or medication
Blood sugar (diabetes) management through nutrition, exercise and/or medication
Personalized exercise prescription
Heart healthy eating plan
Smoking cessation advice and/or treatment
Weight management programs
Stress management techniques

What research is being done?

Currently, the Women's Ischemia Trial to Reduce Events in Non-Obstructive CAD (WARRIOR) is enrolling women. This study is being conducted to determine the best treatment for females who have heart disease without major blockages. More information can be found on the clinical trials webpage. .