Nov. 3, 2003 -- Chest pain or discomfort and arm numbness are considered two of the classic warning signs of a heart attack, but this appears to be less true for women than for men, a new study shows.
In a survey of female heart attack survivors, 70% reported unusual fatigue in the weeks before the event, while just less than one-third reported chest discomfort. A significant percentage -- 43% -- reported no chest pains during their heart attacks.
"I think this may be one reason why women don't seek help during heart attacks as often as men," says researcher Jean C. McSweeney, PhD, RN, who is a professor at the University of Arkansas for Medical Sciences. "We have promoted the idea that heart attacks involve chest pain, but this is not true for a significant number of women."
Early Warning Signs
The findings show that symptoms not often associated with coronary problems might help predict heart attacks in women. In the survey of nearly 500 women who had had heart attacks within the previous six months, 95% reported having new or different symptoms more than a month prior to the heart attack that resolved with the event.
Unusual fatigue in the weeks leading up the heart attack was cited most often, but almost half reported having trouble sleeping and just over one-third reported being unusually anxious. Roughly 40% of the women reported having unusual shortness of breath or indigestion -- symptoms more commonly associated with coronary events.
All of these unusual symptoms resolved after the heart attacks, leading many of the women to conclude that they were linked to the events. Just over half of the women -- 57% -- reported chest pain as a symptom during their heart attacks, while 58% reported shortness of breath, 55% reported unusual weakness, 43% reported unusual fatigue, and 39% reported dizziness. For those women that reported chest pain, the main location was either the back, between or under the shoulder blades, or the high chest area.
The findings are published in the Nov. 25 issue of the American Heart Association journal Circulation.
Women at Risk
Complaints of fatigue, anxiousness, and trouble sleeping are common among aging women (who are also at higher risk for heart attacks) and could be indicative of a host of other health problems. But McSweeney says healthcare providers need to recognize that they may also be early warning signs of heart attack in women at risk.
"A major message here is that women really need to listen to their bodies and their healthcare providers need to listen to them," McSweeney says. "If they have other risk factors for heart attack, then these kinds of changes should not be ignored."
Cardiologist Nieca Goldberg, MD, says she recognized early in her career that women and men commonly experience heart attacks differently. The author of the book, Women Are Not Small Men: Lifesaving Strategies for Preventing and Healing Heart Disease, Goldberg says the new research should help others understand this as well.
"If these symptoms are recognized early as warning signs of a heart attack then we may be able to stop it in its tracks," she tells WebMD. "Women and their doctors have to understand that chest pain is not necessarily the main sign of a heart attack."
Goldberg practices at Lenox Hill Hospital in New York City, and is a spokeswoman for the American Heart Association.
Preventing Heart Attacks
The most of the women included in the study were white, and McSweeney tells WebMD that it is unclear if women of other races have the same early warning signs and acute heart attack symptoms. Because the study did not include a control group of women without diagnosed heart disease, it is unclear whether the early symptoms reported by the women can actually be used to identify women at risk and prevent heart attacks from occurring.
But Goldberg says it is clear that it is not too soon for healthcare providers to consider symptoms such as unusual fatigue and problems sleeping as possible signs of an impending heart attack in women.
"Recognizing that these symptoms, could mean the difference between identifying and treating problems before the event or ending up in the ER with a heart attack," she says.