Classic heart attack symptoms often absent in women

Barbara Sufian was preparing lunch when she felt a sharp pain that radiated from her waist, up her back and to her right shoulder.

“I was right in the middle of heart attack and had no idea what was going on,” Sufian said of the Oct. 24 medical emergency.

With a sister who had a heart attack at age 41 and two brothers who underwent heart bypass surgery, Sufian said she was aware of the typical symptoms. But because Sufian didn’t feel any pain on her left side, she didn’t think it was a heart attack. And that almost cost the 62-year-old woman her life.

“Historically, we have been told if you are having a heart attack the pain goes up your arm on the left side to your neck and face,” Sufian said. “If I had one of those symptoms, I would have gone to the doctor.”

It’s only when she collapsed that she realized she might be having a heart attack and called 911.

She was taken by ambulance to Lawrence Memorial Hospital, where she had a second heart attack.

“I feel pretty fortunate to be alive,” Sufian said.

What Sufian didn’t know was that signs are different between men and women. According to the Women’s Heart Foundation, women wait longer to go to the emergency room during a heart attack, and physicians are slower to recognize that a heart attack is occurring because often the telltale signs of chest pains and EKG changes aren’t present. Each year more women than men die from heart disease. And, after having a heart attack, women are twice as likely to die within the first couple of weeks.

While heart disease is just as serious in women as it is in men, decades worth of research has been focused on men. One of the reasons is because a large national data set came from patients at veterans hospitals. And those hospitals overwhelming cared for male patients.

For both men and women, the most common heart attack symptom is chest pain or discomfort, according to the National Heart, Lung and Blood Institute. But the health organization warns that women are more likely than men to experience other symptoms, such as shortness of breath, nausea or vomiting or back or jaw pain. Women can also have pain in the arms, neck, jaw and stomach.

Women are beginning to recognize those differences, said Dr. Roger Dreiling, a cardiologist at Lawrence Memorial Hospital.

He pointed to a patient he saw over Thanksgiving. She was out taking a walk when she started feeling pain, but it wasn’t in her chest. She was 54, had no risk factors for heart disease, but knew women’s symptoms for heart attacks could be a bit different than men’s. So she went to the emergency room where an EKG showed she was having a heart attack.

Dreiling said it is more common for women to come in with angina, a pain or discomfort that occurs when the heart isn’t getting enough oxygen, than heart attacks. Angina occurs during everyday physical activities. The pain can show up in unexpected places, like the high back and even right elbow.

One of the reasons women may have a lower threshold for coronary heart disease than men is because their arteries are smaller, so it doesn’t take as much plaque to block them. And, one of the reasons they may have a tougher time recovering from a heart attack is that they are on average older. The average age for coronary heart disease in men is 56 or 57. For women it’s 10 years later.

Looking back, Sufian said she had warning signs even earlier than the day of her heart attack. During the previous two months, she would get a sharp pain in her shoulder while directing choir music for her church. But she just thought it was a sore muscle.

A 2003 report by the National Institutes of Health showed that 95 percent of the women studied often experienced new or different physical symptoms as much as a month before a heart attack. Those symptoms included unusual fatigue, sleep disturbances, shortness of breath, indigestion and anxiety. All of those symptoms were more common than chest pains or discomfort.

Sufian’s recovery wasn’t an easy one. She spent three weeks at LMH and another two and half weeks at a rehabilitation center in Kansas City, Kan. She had two stents put in her heart and a pacemaker.

And there were complications along the way. At one point, her kidneys started shutting down, and she wasn’t taking any oxygen in. Her daughter began spreading word among friends and family that it was time to say their goodbyes.

“I just decided I wasn’t going to die. I was going to live. I was going to walk home,” Sufian said

.Last week Sufian arrived home, where she continues her recovery.

“Pay attention to your body,” she advises women. “If something says it’s not right, it probably isn’t.”

By Christine Metz

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