Her Guide to a Heart Attack: Recognizing Female Heart Attack Symptoms

On a Monday morning in April, Merle Rose, a New Jersey woman, 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 had chest pain-a "typical" male heart attack sign. When she got to the emergency room, doctors couldn't find any sign of heart attack and Rose says, "They would have sent me home."

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

In the emergency room, physicians had assumed she 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 regular doctor ordered testing that uncovered major blockages, doctors still made no mention of heart attack, she says.

So when did she finally get word? 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 center of the chest, which may spread to the neck, shoulder or jaw;
• Chest discomfort with lightheadedness, fainting, sweating, nausea or shortness of breath;

But many women don't 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 emergency room 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 recognize that might not be their symptom," says Nieca Goldberg, MD, a cardiologist and chief of Women's Cardiac Care at Lenox Hill Hospital in New York City and author of "The Women's Healthy Heart Program."

"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