“My neck felt a bit funny, like it was parched,” the Collins, Ohio, resident said. “I didn’t really have pain, but there was some tightness.” Mesenburg, then 60, woke up the next morning with pain in her jaw and arm and felt a bit nauseous. A registered nurse who had recently retired, Mesenburg knew these could be the signs of a heart attack. However, since she also had GERD (gastroesophageal reflux disease), she thought it might just be heartburn. “I hadn’t been exercising much, but I saw my primary care doctor every year and had never had any issues with my heart before,” she says. “I thought I was relatively healthy.” But a couple days after her initial symptoms began, she realized she was not getting better and went to her local emergency room. That’s where doctors told her she was having a heart attack.
Symptoms of a Heart Attack Can Be Different for Women and Men
Heart disease is the No. 1 killer of both men and women in the United States, accounting for about 1 in 4 deaths, according to the Centers for Disease Control and Prevention (CDC). A heart attack is a medical emergency that occurs when blood flow to the heart is reduced or obstructed because the arteries that supply blood to the heart have narrowed, according to the American Heart Association (AHA). The classic portrayal of a heart attack in movies is a man clutching his chest in pain. But like Mesenberg, many women experience heart attacks very differently than men. “While chest pain is the most common symptom of a heart attack among men and women, women are more likely to have ‘atypical symptoms,’” says Ijeoma Isiadinso, MD, a cardiologist and associate professor of medicine at Emory University School of Medicine in Atlanta. According to the AHA, these include:
fatigueshortness of breathback or jaw painnausea or vomiting
Since women are more likely to have atypical symptoms of a heart attack, this can result in a delay in seeking medical care, as was the case for Mesenberg. “This is especially true if medical professionals or patients do not recognize these symptoms when they occur,” Dr. Isiadinso says. For Mesenberg, doctors quickly realized the severity of her condition. She was transferred to the Cleveland Clinic in Ohio, where she underwent a cardiac catheterization procedure and triple bypass surgery. She started a cardiac rehab program and got back on track with a healthy living plan. Now, nearly three years later at the age of 63, she’s feeling healthy, sticking to a heart-healthy diet, and exercising regularly. Still, if she could do things differently, she says she would have sought help much sooner. “Denial is a really powerful thing,” she says. “I knew better, but I didn’t think it was going to happen to me.”
Women Are More Likely to Die of Heart Attacks Than Men
Research shows that women have a higher rate of death from heart attack than men. In fact, a study published in 2018 in the Journal of the American Heart Association found that women were up to 3 times more likely to die following a serious heart attack than men as a result of unequal treatment. The delay in seeking care due to atypical symptoms in women is one reason for this, but it is not the only piece of the puzzle. When it comes to the type of heart attack men and women experience, there is also a difference between the sexes. “Men are much more likely to have what we call epicardial disease, which [affects] the big arteries that run on the outside of the heart,” explains Deirdre Mattina, MD, a cardiologist at the Cleveland Clinic. “These are the big vessels we can see with our eyes when we do a heart catheterization, and those are the vessels we can put stents in or do bypass surgery to.” Women, on the other hand, are much more likely to have microvascular disease. This affects a network of much smaller arteries within the walls of the heart. “Unfortunately, what this can lead to is misdiagnosis and undertreatment in women because even if a woman presents with chest pain, between one-third to two-thirds of the time when we do a heart catheterization procedure, we see no blockages in the big epicardial arteries,” Dr. Mattina says. “We are now learning how important the microvascular system is and that you can have many of the same symptoms and really bad outcomes with dysfunction of the microvascular circulation.” What’s more, research is still being done into the best treatment for microvascular dysfunction. “We think a lot of the same medications used for epicardial heart arteries, like ACE inhibitors, beta-blockers, calcium channel blockers, aspirin, statins, and cholesterol medication, have similar effects but a lot of that work is still in progress,” Mattina says.
Other Heart Disease Risk Factors Specific to Women
Traditional risk factors for heart disease include hypertension (high blood pressure), diabetes, smoking, family history of heart disease, obesity or physical inactivity, age, and high cholesterol, according to the CDC. But, Isiadinso notes, “there are additional risk factors that are unique to women, and it is important that both women and their healthcare providers are aware of them. “Polycystic ovarian syndrome, menopause, and autoimmune inflammatory diseases (such as rheumatoid arthritis, lupus, and psoriasis) also increase a woman’s risk for heart disease,” she continues. Pregnancy can also have a major impact on a woman’s heart. “Pregnancy is often considered a ‘stress test’ for women,” Isiadinso says. “We can learn a lot about a woman’s future risk for heart disease based on her pregnancy history. Women who develop complications such as hypertension, including preeclampsia or eclampsia, or diabetes during pregnancy are at increased risk of developing heart disease later in life.”
A Worrying Decline in Awareness Among Women
While the AHA and a number of other advocacy groups have pushed awareness campaigns around signs of heart disease in women in recent years, progress appears to have plateaued. An AHA special report published in September 2020 in the Association’s journal Circulation found glaring gaps in awareness of heart disease risk, particularly among young women and women of color. Awareness among women that heart disease is their leading cause of death declined significantly over the last decade from 65 percent of women being aware in 2009 to 44 percent being aware in 2019. Women were also more likely to erroneously believe that cancer is the leading cause of death in 2019 than 10 years prior. The greatest declines in awareness were seen among Hispanic women, Black women, and women ages 25 to 34 years old. “This is quite disappointing news and means despite our best efforts we are not reaching women, especially women of color,” says Mattina. “We have a lot of work to do, a lot of education and we really have to think about how we’re messaging this to the population at large.” Experts say it’s imperative that women are aware of the risk factors for heart disease and work toward prevention. “Work with your medical provider to make sure your blood pressure, blood sugars, weight, and cholesterol are controlled,” Isiadinso says. “Exercise, limit your alcohol intake, and follow a heart-healthy diet. If you smoke, quitting tobacco could be one of the most important steps to prevent heart disease.” She also urges women to be aware of the symptoms of a heart attack, especially those that are atypical. “If you have any of these symptoms, seek immediate medical attention,” Isiadinso says. “Don’t delay seeking care.” Finally, Mesenberg urges other women to trust their instincts. “We all know our own bodies,” she says. “We know when something feels different. Listen to those signals.”
