HealthLINK: Cardiac: Signs of impending heart attacks among women

Unusual symptoms in women warrant a closer look

This is a well-designed study that examines an area about which little has been written—women’s heart attack symptoms. It makes the important point that women experience a whole different constellation of symptoms than those classically described, which is an important area of inquiry, particularly since more women than men present with sudden cardiac death (see July 2003 women’s HealthLINK).

“Women experience a whole different constellation of symptoms than those classically described.…”

An overwhelming majority of the women in this study, 95 percent, experienced new or different symptoms more than a month before their heart attacks that resolved after their heart attacks. This led them, in retrospect, to believe those symptoms were related to the subsequent attacks. It is difficult, however, to know just how to apply these findings prospectively to predict who is likely to be in imminent danger. How do we sort out from this information just who is going to have a heart attack?

Fatigue
Fatigue seems to be the most prevalent and striking symptom. Nearly 70 percent of these women reported extreme fatigue. In my practice, I try to identify women who have unusual fatigue that they are unable to link to exercise or stress. Many women with hectic schedules get tired, but often they’re able to power through their fatigue to get through their daily work.

“Fatigue described by women who go on to have heart attacks is unusual in its severity.”

The fatigue described by women who go on to have heart attacks is unusual in its severity. It prevents them from doing tasks they generally can accomplish even when tired, such as making a bed.

Other symptoms
Severe sleep disturbances and shortness of breath are also helpful symptoms to alert us to the possibility that an attack may be imminent. I look for a pattern of change among my patients—new symptoms or symptoms that have changed in severity or frequency.

Cardiac testing may be next step
If these symptoms coexist with the risk factors we associate with cardiovascular disease—family history, obesity, diabetes, high blood pressure and/or cholesterol and smoking—I would be inclined to have a patient undergo a series of cardiac tests, beginning with an electrocardiogram or EKG.

If necessary, I would recommend the woman undergo a stress echo, which combines two tests, a treadmill stress test combined with an echocardiogram, an imaging technique that looks at the heart muscle’s response to exercise. The stress echo has proven to be the most accurate diagnostic test for women, yielding fewer false positives than other forms of stress tests.

Women who have an abnormal stress test might go to the cardiac catheterization laboratory for more invasive diagnostic tests and possibly for an angioplasty with or without a stent to clear obstructed coronary arteries.

What can you do?
Be sensitive to your body.
In this study only 30 percent of the women reported chest pain prior to having a heart attack and many of those who reported chest pain described it in terms such as aching, tightness and pressure, rather than pain.

Know your risk factors for cardiovascular disease.
Establish a relationship with a physician and discuss your specific heart disease risk factors with him or her. Work with your doctor to establish an action plan to reduce your risks. Pay attention to marked differences in how you feel and contact your doctor if you are experiencing any of the unusual symptoms, such as those mentioned in this study.

Learn more about women and heart disease.
Yale-New Haven Hospital has developed a national program designed to teach women more about what they need to know to protect themselves and those they care for. Read more about Women’s Heart Advantage.

Dr. Freed is a cardiologist and an associate with The Cardiology Group with offices in New Haven and Branford. She is an attending physician at Yale-New Haven Hospital and Yale-New Haven Heart Center.

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