Especially for women, some signs are surprising

by: Elizabeth Agnvall | from: AARP Bulletin | February 11, 2011

If you Googled this article because you think you're having a heart attack — stop. Call
911. Then chew an aspirin.

Spending precious minutes searching for information about heart attack symptoms as
you experience them is not wise, doctors say, because "time is heart muscle."
Heart Attack Symptoms

One of the symptoms for a heart attack in women is pain in the shoulder blades. —
Rosanne Olson/Getty Images

"If you think you're having a heart attack, that's not the time to try and figure out
whether you're right," says Gordon Tomaselli, M.D., president-elect of the American
Heart Association, who adds he has patients who have done exactly that.

And yet, among the most commonly searched subjects online is "heart attack signs,"
according to the search engine Google. In fact, the number of searches for that term
has increased by a whopping 90 percent in the last five years or so, according a
company spokesperson. Searches for "Am I having a heart attack?" alone have risen
by more than 35 percent since 2008, the company says.

One reason people are searching online for emergency information is that it's not
always easy to tell whether you're having a heart attack — even doctors have a tough
time knowing without tests. If you suspect you're having a heart attack, call for an
ambulance immediately. And don't be embarrassed if it turns out you're not.

"It's not always straightforward," says Tomaselli. "If you develop the classic symptoms
— pressing chest pain, sweating, nausea — then you're pretty clear that there's a big
problem that needs to be dealt with quickly." But, he says, many people, especially
women, may develop completely different symptoms when experiencing a heart attack.

Common symptoms in men and women:

You should pay particular attention to the following signs if — like more than half of all
Americans — you are over 50, have high blood pressure, have high cholesterol, are a
smoker or have a family history of heart disease. A heart attack occurs when the blood
supply to the heart is blocked, damaging the muscle. Chewing aspirin (either one
regular or two baby) helps the heart by thinning the blood.

* Chest pain — Most people do call 911 or get to the hospital if they feel like they've
got an elephant sitting on their chest, but even this most common heart attack
symptom may be hard to recognize. It may just feel like a squeezing that lasts more
than a few minutes or goes away and comes back. "It may be a chest fullness that they
don't recognize as pain," says Tomaselli, who is also chief of cardiology at the Johns
Hopkins School of Medicine. "Sometimes it doesn't particularly hurt. It's an
uncomfortable sensation." If chest pain lasts more than five minutes, go to the
emergency room.
* Shortness of breath — You may feel that you can't catch your breath, even when
resting. This breathlessness often occurs before the chest pain.
* Dizziness or lightheadedness — You may feel as if you will pass out.
* Cold sweat — Sweating when you are cold or have a chill.

Symptoms more likely in women:

Women have a higher risk of dying from a heart attack than men do, partly because
they often don't realize they're having a heart attack and partly because they delay
getting help. Women are less likely than men to have the typical "Hollywood heart
attack," says Sharonne Hayes, M.D., cardiologist and director of the Mayo Clinic's
Women's Heart Clinic in Rochester, Minn. Chest pain was not the main symptom in
about 46 percent of women who had a heart attack, studies show.

* Pain in the arm (especially left arm), back, neck, abdomen or shoulder blades —
When the nerves of the heart are irritated because the heart isn't getting enough
blood, discomfort or pain can radiate out to many places in the body. The pain often is
described as an uncomfortable pressure, tightness or ache. "If you can put a finger on
it and say, 'It hurts right here,' that's much less likely to be a heart attack," says Pamela
Ouyang, a cardiologist with the Johns Hopkins Bayview Medical Center.
* Jaw pain — Jaw and throat pain are quite common, says Ouyang. She says the feeling
can start in the chest and move to the throat — as if someone is choking you — and
then to the jaw. But again, it's not always obvious. Sometimes people "go to the
dentist, because they think it's a toothache," when they actually had a heart attack.
* Nausea and vomiting — Women are more likely than men to have this symptom, and
they may think they have a stomach flu rather than a heart attack.
* Overwhelming and unusual fatigue — Fatigue is generally a symptom of 21st-century
life, so it's often overlooked as a heart attack sign, but it's extremely common, so
beware if you're unusually exhausted.

Which is it?

* Heart attack vs. heartburn — If you typically have heartburn, and you've just eaten a
large or spicy meal, you may want to take an antacid to see whether the pain goes
away, advises Ouyang. "If you've never had anything like this before, and particularly
if it's quite severe or you have a sweat with it ... then it might be a heart attack."
* Heart attack vs. panic attack — If you have a history of panic attacks — racing heart
or feelings of impending doom — the symptoms may be another panic attack. But if
you've never had a panic attack, Hayes says you should be checked out because you
don't want to wind up ignoring a real heart attack.
* Heart attack vs. stable angina — Angina — the pain that comes from insufficient
blood flow to the heart — feels similar to a heart attack, but tends to come and go as
you exert yourself. "If there is some kind of activity that brings on these symptoms
and then you rest and it goes away, that is a classic symptom of angina," Ouyang says.
Sweating and shortness of breath are more likely to accompany a heart attack. Angina
is often a precursor to a heart attack, so people need to see a doctor and get
diagnosed quickly.

Dinner Can Wait

Heart experts say one reason so many women die is that they often don't heed their
symptoms. They may attribute their symptoms to hot flashes, flu, something they ate or
their age. When they do realize something might be wrong, they delay getting

"Women don't call 911," says Sharonne Hayes, M.D., of the Mayo Clinic.

In fact, a 2009 American Heart Association survey found that only half of women say
they would call 911 if they thought they might be having a heart attack. "They worry,
'What will the neighbors think?' or 'I've got to finish fixing dinner for my husband,' "
Hayes says.

And women are more likely to consult with friends or call the family doctor, which
Hayes says can cause a dangerous delay.

Studies also show that women who are diagnosed with a heart attack are more likely
to have come to the hospital in a private car.

When people arrive at a hospital by ambulance, they usually get faster treatment,
Hayes says.

"Patients should not be sitting at home trying to diagnose a heart attack," Hayes says.
"They could die doing that."

Cardiologist Gordon Tomaselli says that often after people have a heart attack, they
realize in retrospect they had symptoms days or weeks earlier that they didn't
recognize — such as extreme fatigue or throat pain.

But as many as a quarter of all heart attack victims have a heart attack as a first
symptom of heart disease.
Am I Having a Heart Attack?