Heart disease health centre

Her guide to a heart attack: Recognising female heart attack symptoms

On a Monday morning in April, Merle Rose experienced what some doctors call "female heart attack symptoms;" a feeling of indigestion and extreme fatigue. Later, she had nausea, vomiting and fainting.

But she never experienced chest pain - a "typical" male heart attack sign. When she got to hospital, the doctors couldn't find any sign of a heart attack and Rose says, "They would have sent me home".

As Rose's experience shows, many doctors - and women themselves - still don't realise that female heart attack symptoms can look very different from those of men. In fact, according to a study of women's early heart attack signs published in the US publication, Circulation, women have more unrecognised heart attacks than men and are more likely to be mistakenly diagnosed and discharged from emergency departments.

In hospital, doctors had assumed Merle Rose had a gastrointestinal illness. But at the time, no one told Rose that she had suffered a heart attack.

When an outside cardiologist recommended by Rose's usual doctor ordered testing that uncovered major blockages, doctors still made no mention of a heart attack, she says.

So when did Rose finally find out? Not until several months later, when she visited a new female cardiologist. This doctor told her in retrospect that she had suffered a textbook case of undiagnosed female heart attack.

"That's the first I ever heard", Rose says. "This doctor told me, 'They didn't connect the dots'".

Female heart attack symptoms: What are they?

These chest-related heart attack signs often appear in men, and many women get them, too:

• Pressure, fullness or a squeezing pain in the centre of the chest, which may spread to the neck, shoulder or jaw;
• Chest discomfort with lightheadedness, fainting, sweating, nausea or shortness of breath;

The British Heart Foundation says that women tend to suffer the less typical symptoms of heart attack, such as a mild discomfort in the chest that makes you feel unwell, feeling a bit light headed or dizzy and chest pain that feels like bad indigestion.

Many women don't even have chest pain. In the Circulation study on early female heart attack symptoms, researchers found that during a heart attack, 43% of the 515 women studied had no "acute chest pain... a 'hallmark symptom in men’", according to study authors.

Nevertheless, the study cited evidence that many accident & emergency doctors still look mainly for chest pain. Only a minority check for the other types of symptoms that women tend to develop. As a result, doctors may miss heart attacks in women.

"Although women can have chest tightness as a symptom of a heart attack, it's also important for women to recognise that might not be their symptom," says Dr Nieca Goldberg, a cardiologist. .

"Women commonly have symptoms of shortness of breath, unexplained fatigue, or pressure in the lower chest, so they easily mistake it as a stomach ailment".

In the Circulation study, common female heart attack symptoms include:

• Shortness of breath (57.9%)
• Weakness (54.8%)
• Unusual fatigue (42.9%)

Women also had these symptoms:

• Nausea
• Dizziness
• Lower chest discomfort
• Upper abdominal pressure or discomfort that may feel like indigestion
• Back pain