You've seen it many times: A man clutches at his chest and buckles in agony. It's what cardiologist Laxmi Mehta calls "the Hollywood heart attack." But for women, that stereotype can hurt more than it helps. While chest pain is the most common heart attack symptom in women, it may not be the first. As a result, heart attacks are often harder to spot.
Women's symptoms can be subtle, such as extreme fatigue. Some women experience an uncomfortable sense of squeezing or burning in the chest or pressure in the lower chest or upper abdomen. Others feel back pain, experience nausea or vomiting, feel dizzy or experience jaw or neck pain.
Dramatic and unfamiliar symptoms and pain that worsens on exertion and then slows or stops when you do are worth checking out, says Mehta, director of the Women's Cardiovascular Health Program at Ohio State University's Wexner Medical Center. A sudden cold sweat or severe abdominal pressure are also reasons for concern. For some women, heart attack signs and symptoms may not take place all at once. Rather, they can build over time or begin as long as a month before the attack becomes evident.
Symptoms aren't the only difference, Mehta says. Women can experience classic heart attacks, in which an artery is completely blocked, but they typically experience partial blockages more often than men. These partial blockages are more difficult to detect. Women are also more likely to undergo a coronary artery spasm, in which the heart tightens and temporarily reduces blood flow into the beating muscle.
But the biggest danger may be a woman's unwillingness to acknowledge a problem. Because heart attacks are often perceived as "a guy thing," Mehta says, she finds that women often don't take their symptoms seriously, or prioritize other people's well-being above their own. Meanwhile, every minute without treatment chips away at the chances for a good outcome. "I can only treat you if you show up," Mehta says.
Unfortunately, she says, some health-care providers don't recognize subtle symptoms in women and don't consider that a heart attack might be happening. If you suspect a heart attack, she recommends, push for answers even if your provider is skeptical. "If someone is not well versed in the uniqueness of females' hearts, then you need to advocate for yourself."
Other differences between men and women include disparities in who participates in cardiac rehabilitation — an estimated 80 percent of affected women don't receive the full rehab they should get — and women's higher risk for complications, such as bleeding, shock and stroke, during recovery. Researchers have more to learn, in part because science has long downplayed women's symptoms.
"We know these differences exist," Mehta says. "But why don't we have enough research on this uniqueness?" Meanwhile, heart disease is the No. 1 killer of women — and that's a risk no one can afford to ignore.
Learn more: heart.org (search for "women and heart disease").