'Be proactive. Don't ignore it': Recognising 'vague' heart attack signs in women

There are certain diseases or illnesses that are historically more associated with men than women. Heart attacks are one of those.

But the idea that heart issues affect men more than women is dangerous, and what’s more, inaccurate.

In fact, one in four women in Ireland die of heart disease each year, the exact same figure as men. And a woman is six times more likely to die from heart disease than breast cancer.

Yet, there is a lack of awareness of what a heart attack looks like in a woman; 50% of women don’t know the signs and symptoms of heart disease, according to research conducted by the Irish Heart Foundation.

The familiar representation of a heart attack, or a “Hollywood heart attack” as Noel Caplice, Consultant Cardiologist at Cork University Hospital (CUH) and the Chair and Professor of Cardiovascular Sciences at UCC, calls them, can present with “severe central chest pain sometimes coming up into your neck or the jaw. You might be sweaty. You might be short of breath. You might feel like you have heartburn”.

This is the classic understanding we have of a heart attack, but these symptoms are “much more common in men”, explains Professor Caplice.

“And so, unfortunately, our ideas about heart attacks have really been generated from a male perspective, and that’s because, more than 20 years ago, we would have thought that a woman’s risk of heart attacks was much lower.

“What we’re seeing now though is that women, particularly over the age of 50, are at a similar risk as men in experiencing a heart attack.”

The heart attack symptoms that women experience can differ from the ‘Hollywood heart attack’.

“Women can present with chest pain, but more commonly, they have other symptoms. And this is the real problem because the other symptoms are not classic for heart attacks.

“So, things like dizziness, uncomfortable pain between the shoulder blades, indigestion or a gas-like pain, a feeling of fullness. Other vague symptoms like fatigue and sleep disturbance. Shortness of breath is quite common, or more common in women as a presentation rather than the classic chest pain.”

Because the symptoms are slightly different to what we associate with a heart attack, women tend to ignore them more often, says Professor Caplice, which means they don’t come to the attention as quickly as men do.

“Where they’re getting all these vague symptoms, and they can’t make head or tail of them, they may ignore them and think, ‘I’m gonna get better. I’ll just go to sleep. I’ll take some rest. I’ll be okay’”.

For the most part, women are the primary caregivers in the home, and often prioritise their children, and their partners over themselves. This can lead to delays in presenting to the hospital too.

Like with any serious illness, early intervention with a heart attack is key.

“If you can present earlier after the initiation of a heart attack, you’re going to have a better outcome.

“If you present late, particularly after 12 hours or over 24 hours, a lot of the damage is done, and our ability then to open up the artery is diminished,” explains Professor Caplice.

“Delays in presentation for someone who is having a heart attack can lead to more heart damage, heart failure, rhythm disturbances and even death.

“Time is muscle, so the sooner the blocked artery is opened, the more likely the heart will recover,” explains Dr Angie Brown, Consultant Cardiologist and Medical Director, Irish Heart Foundation.

Worryingly, people can often ignore chest pain in the hope that it will go away.

Around 10 years ago, one of Professor Caplice’s medical students conducted a study, where they asked people in Cork a simple question: if you had chest pain, what would you do?

Twenty per cent of those asked said they would go to bed and wouldn’t tell anyone.

“This is a killer statistic,” says Professor Caplice. “This is the real impact we can have on society, to make sure they know that if you have chest pain and it isn’t going away within 15 minutes, they should be ing someone to resolve the problem. Be proactive. Don’t ignore it.”

So what can women do to preserve their heart health? Professor Caplice says, for the most part, it’s about being more aware of your health. If you’re a smoker - stop, and take a proactive approach.

“Get your blood pressure checked regularly. We’re seeing now, which is great, that pharmacies are doing blood pressure checks for younger people, even 20-30 year olds.

“Also, know your cholesterol levels; the good thing is, if you’re a woman, particularly under 55 and your blood pressure is normal and you don’t smoke, then your risk of a heart attack is extremely low. These are simple things you can do.”

The good news is 80% of premature cardiovascular disease is preventable, says Dr Brown.

“Physical activity is one of the greatest tools for prevention of cardiovascular disease. A minimum of 150 minutes of moderate-intensity activity a week divided into manageable and enjoyable sessions is recommended.”

Diet can also play an important role. Among the medical profession, the Mediterranean diet is widely considered to be heart-healthy. With its emphasis on fresh vegetables and fruit, it can help to reduce the risk of heart disease, explains Professor Caplice.