Heart attacks: His versus hers

The camera zooms in on a man. He’s middle aged, possibly a little overweight, and clutching his chest. He grunts; his face is sweaty and his features contorted in pain. Around him, alarmed bystanders jump into action, whipping out cell phones and helping him to a chair before he collapses.

If all heart attacks looked like the Hollywood stereotype, we would know right away what was happening and immediately call 911. In real life, the symptoms are often less dramatic, and a failure to recognize them can lead to dangerous delays getting help — especially for women.

According to the Heart and Stroke Foundation of Canada, about 70,000 Canadians suffer a heart attack each year, and roughly 16,000 people will die as a result. Heart attacks are responsible for one quarter of all cardiovascular disease deaths (the top cause of death in Canada).

While men have a higher risk of having a heart attack than women, and have them at a younger age, women often experience subtle or unusual symptoms. According to a new survey, not recognizing the signs — or seeking help soon enough — can have disastrous consequences.

Delays can be deadly for women

Prompt treatment for a heart attack is crucial for a good outcome — and the earlier you get treatment, the better. Heart attacks occur when a blood clot blocks the flow of blood to the heart and deprives this crucial muscle of oxygen. The longer it goes untreated, the more permanent damage can be caused.

Not getting help quickly enough can turn deadly. According to the British Heart Foundation (BHF), people who are treated within two hours of symptoms first appearing are twice as likely to survive as people who are not treated within four hours. In Britain, one third of people die before reaching the hospital — often because they wait too long. In Canada, most heart attack deaths occur outside of a hospital.

But here’s the scary part: one survey from the BHF found that what women don’t know about heart attacks can kill them. One third of the women surveyed said they wouldn’t recognize they’re having a heart attack unless they were experiencing crushing or severe chest pain (a symptom more characteristic of heart attacks in men). However, experts have long known that women are more likely than men to experience less dramatic symptoms, and may not have chest pain at all. As a result, they may be overlooking or dismissing dangerous signs.

Worse yet, women may be afraid to seek help because they don’t want to cause a fuss. The survey found that 35 per cent of women wouldn’t call emergency services because they’re afraid of being embarrassed if it turns out to be something minor.

“There is no need to feel embarrassed about getting it wrong,” says Dr. Mike Knapton, BHF Associate Medical Director, in a recent press release. “Saving your life is more important than saving face.”

Furthermore, even when they do recognize the signs of trouble, women tend to wait longer than men to call emergency services. The lag time? An average of 24 minutes (according to previous research), which is far too long to wait in a life-or-death situation. Some previous U.S. studies found that women may wait up to an hour longer than men — putting them at or beyond the four hour mark from when they first started noticing symptoms.

“Every second counts when you are having a heart attack, and calling 999 [911 in Canada] at the very first sign means you are much more likely to survive,” Dr. Knapton warns.

(Read the British Heart Foundation press release.)

Men’s versus women’s — not as different as we thought?

The study drives home the point that women need to be more aware of symptoms, and understand how their symptoms can differ from men. This awareness is especially important for women, as they tend to have heart attacks at a later age than men when other age-related factors like high blood pressure and diabetes can affect their prognosis.

You may have heard that women’s heart attacks are different from men’s, but there’s still some confusion about what that means. Experts note that the most common symptom in both men and women is chest pain. In both sexes, the pain can be excruciating for some while others may only feel minor pain. Some people experience upper body pain — in the back, shoulders, arms, neck or jaw — with or without chest pain and other symptoms.

So what’s the difference? Women are more likely than men to experience vague or minor chest pain (the kind that feels a pressure or discomfort in the chest). They’re also more likely to have symptoms like nausea, dizziness, upper body pain and shortness of breath without experiencing chest pain at all.

There’s also a question of timing. Women may experience symptoms like unusual fatigue, pain and indigestion up to a month before the actual heart attack. These symptoms can come and go, making them difficult to diagnose and easy to attribute to other causes.

The bottom line: Both men and women can experience unusual symptoms. However, women are more likely to present with these subtle symptoms and may not experience typical chest pain.

Recognizing the signs*

Medical experts warn to watch out for these common symptoms:

– Pain in the chest. It may feel like an ache, burning pressure, fullness or squeezing in the centre of your chest.

– Chest pain or discomfort that is brought on with exertion and goes away with rest.

– Difficulty breathing or shortness of breath.

– Nausea or vomiting.

– Sweating, and cool, clammy skin.

Less common symptoms include:

– Vague or dull chest pain, or a discomfort in the chest that makes you feel unwell.

– Upper body pain in the neck, jaw, shoulder, arms or back. (These symptoms can occur without chest pain.)

– Stomach pain that feels like a bad case of indigestion.

– Anxiety, fear or denial (it could feel like a panic attack with no apparent cause).

– Light-headedness (may feel dizzy, or feel like you could pass out).

– Unusual fatigue (which gets worse with activity).

– General feeling of weakness.

– Paleness.

(*This list of symptoms was compiled from the British, Canadian and American heart charities as well as information from the Public Health Agency of Canada, the Mayo Clinic and WebMD.)

So what’s the take-home message? Both men and women can experience common or less common symptoms, but women are more likely to experience the less common ones.

Essentially, it doesn’t matter which sex you are, it’s important to know all of the symptoms of a heart attack so you can recognize them (in yourself or in someone else) more quickly and get help as soon as possible.

For more information on women’s heart health, see Women and heart disease.

Canadian Heart and Stroke Foundation: Heart attack warning signals

Public Health Agency of Canada: What are the Symptoms of Heart Attacks in Women?

Mayoclinic.com: Heart attack symptoms: Know what signals a medical emergency

Additional sources: British Heart Foundation, American Heart Foundation, WebMD.

Photo ©iStockphoto.com/ Renee Lee

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