Most women know the symptoms of a heart attack squeezing chest pain, shortness of breath, nausea. But as it turns out, these symptoms are more typical for males. Female heart attacks can be quite different — and it’s important for all women to learn the warning signs.

Rhonda Monroe’s story is a cautionary tale. She was mystified when strong pain struck her left breast and left arm. Monroe, who was a 36-year-old mother of three, didn’t know it at the time, but she was having early symptoms of a heart attack. “I certainly wasn’t thinking about my heart because I was young and healthy and had been skinny,” she says.

As the pain moved into her shoulder and back, Monroe took pain relievers and showered for relief. But the next day, she was overwhelmed with nausea, sweating, vomiting, and chest pain. An ambulance rushed her to the emergency room.

Causes of a heart attack in women

Heart attacks occur when the flow of blood to the heart is blocked by a buildup of plaque in coronary arteries. While the initial causation can often be pinned on the usual suspects heavy smokers, people with high-stress lifestyles, or those who are excessively overweight the not-so-usual suspects can also be at high risk for heart attack.

Heart disease is the No. 1 killer of women, which is why it is imperative that women learn the warning signs and symptoms, see a doctor regularly, and learn their family history.

Symptoms of a heart attack:

• Uncomfortable pressure, squeezing, fullness or pain in the center of your chest that lasts more than a few minutes, or goes away and comes back.

• Pain or discomfort in one or both arms, the back, neck, jaw or stomach.

• Shortness of breath, with or without chest discomfort.

• Other signs such as breaking out in a cold sweat, nausea or lightheadedness.

As with men, the most common heart attack symptom in women is chest pain or discomfort. But it’s important to note that women are more likely to experience the other common symptoms, particularly shortness of breath, nausea/vomiting and back or jaw pain.

What to do during a heart attack

If you experience any of these signs or symptoms:

• Do not wait to call for help. Dial 9-1-1, make sure to follow the operator’s instructions and get to a hospital right away.
• Do not drive yourself or have someone drive you to the hospital unless you have no other choice.
• Try to stay as calm as possible and take deep, slow breaths while you wait for the emergency responders.

These six heart attack symptoms are common in women:

Chest pain or discomfort.

Chest pain is the most common heart attack symptom, but some women may experience it differently than men. It may feel like a squeezing or fullness, and the pain can be anywhere in the chest, not just on the left side. It’s usually “truly uncomfortable” during a heart attack, says cardiologist Rita Redberg, MD, director of Women’s Cardiovascular Services at the University of California, San Francisco. “It feels like a vise being tightened.”

Pain in your arm(s), back, neck, or jaw.

This type of pain is more common in women than in men. It may confuse women who expect their pain to be focused on their chest and left arm, not their back or jaw. The pain can be gradual or sudden, and it may wax and wane before becoming intense. If you’re asleep, it may wake you up.

You should report any “not typical or unexplained” symptoms in any part of your body above your waist to your doctor or other health care provider, says cardiologist C. Noel Bairey Merz, MD, director of the Barbra Streisand Women’s Heart Center at Cedars-Sinai Medical Center in Los Angeles.

Stomach Pain

Sometimes people mistake stomach pain that signals a heart attack with heartburn, the flu, or a stomach ulcer. Other times, women experience severe abdominal pressure that feels like an elephant sitting on your stomach, says cardiologist Nieca Goldberg, MD, medical director of the Joan H. Tisch Center for Women’s Health at NYU Langone Medical Center in New York.

Shortness of breath, Nausea, or lightheadedness.

 If you’re having trouble breathing for no apparent reason, you could be having a heart attack, especially if you’re also having one or more other symptoms. “It can feel like you have run a marathon, but you didn’t make a move,” Goldberg says.

Sweating.

Breaking out in a nervous, cold sweat is common among women who are having a heart attack. It will feel more like stress-related sweating than perspiration from exercising or spending time outside in the heat. “Get it checked out” if you don’t typically sweat like that and there is no other reason for it, such as heat or hot flashes, Bairey Merz says.

Fatigue.

Some women who have heart attacks feel extremely tired, even if they’ve been sitting still for a while or haven’t moved much. “Patients often complain of a tiredness in the chest,” Goldberg says. “They say that they can’t do simple activities, like walk to the bathroom.”

Not everyone gets all of those symptoms. If you have chest discomfort, especially if you also have one or more of the other signs, call 911 immediately.

• Don’t delay getting help. “Women generally wait longer than men before going to the emergency room,” says Rita F. Redberg, MD, MSc, FACC, director of Women’s Cardiovascular Services for the UCSF Division of Cardiology in San Francisco. Even if you think your symptoms aren’t that bad or will pass, the stakes are too high.
• Don’t drive yourself to the hospital. You need an ambulance. If you drive, you could have a wreck on the way and possibly hurt yourself or someone else.
• Don’t have a friend or relative drive you, either. You may not get there fast enough.
• Don’t dismiss what you feel. “Don’t worry about feeling silly if you’re wrong,” Goldberg says. You have to get it checked out right away.

“People don’t want to spend hours in an emergency room if it isn’t a heart attack,” Bairey Merz says. “But women are actually good at deciding what is typical for themselves and when to seek health care.”

Take Care of yourself

Heart disease is preventable. Here are Goldberg’s top tips:

• Schedule an appointment with your healthcare provider to learn your personal risk for heart disease.
• Quit smoking. Did you know that just one year after you quit, you’ll cut your risk of coronary heart disease by 50 percent?
• Start an exercise program. Just walking 30 minutes a day can lower your risk for heart attack and stroke.
• Modify your family’s diet if needed. Check out these healthy cooking tips. You’ll learn smart substitutions, healthy snacking ideas and better prep methods. For example, with poultry, use the leaner light meat (breasts) instead of the fattier dark meat (legs and thighs), and be sure to remove the skin.

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