Heart attack symptoms in women, in their own words

Heart attack symptoms in women, in their own words

Having a heart attack felt nothing like I thought it would feel.   For one thing, unlike sudden cardiac arrrest, in which the heart stops beating and you stop breathing, during my heart attack (myocardial infarction), my heart continued beating, and I was conscious throughout despite horrific symptoms – so how could I possibly be having a heart attack?

Like most women I know, I thought very little about heart disease, even though it is our #1 killer each year. Women need to know all the potential symptoms of a heart attack, and demand help immediately if these symptoms do hit.

Thank you to my Heart Sisters from WomenHeart’s online support community who have generously volunteered to share these compelling survivor stories here with us:

Debra, age 42, USA: “I was under a lot of stress the week I had my heart attack. My first symptom was an odd squeezing sensation in my chest, as if someone reached out and grabbed my heart and squeezed it a few times. No pain – it really didn’t hurt. After my chest sensations went away, my upper back between my shoulder blades started to ache immensely.

Later, I felt an odd numbing/tingling sensation move up my arm, which immediately made me worry and was the reason I went to the ER, as I knew this was a classic heart attack symptom. My chest sensations went away after I used my emergency inhaler (for asthma) as I had mistaken the beginnings of the heart attack as an asthma attack. But my back pain fluctuated, and arm tingling did not go away.  In hospital, doctors found a  94-96 % lesion in my left anterior descending coronary artery (LAD – the dreaded ‘widowmaker’ heart attack) that they were going to stent. But after the first stent was implanted, an area in my artery near the stent dissected (tore) and I had to have emergency double bypass open heart surgery. I did not recognize my initial chest sensations and back pain as a heart attack and as a result I did not seek immediate help. Now approx 41% of my left ventricle is damaged. I was diagnosed with congestive heart failure a few weeks after being discharged for my heart attack.”

Sandra, age 37, USA: “I woke up at 3 a.m. and my first symptom was heartburn, even though I’d eaten nothing that might cause that.  My husband brought me antacids, then a sharp pain went through my back and I told my husband I felt like I was going to die – all in the matter of one minute from the initial symptom.  My heart actually stopped and I had to be defibrillated twice in hospital, and then was unconscious for four days. Three more trips to hospital afterwards, but no plaque, just spasms that felt like heartburn, nausea and sometimes chest pain (it is hard for me to tell the difference!) “

Lidia, age 56, UK: “The first symptom of my heart attack was heartburn – first time I’d had heartburn in 26 years since I was pregnant. I had no pain at all, but this heartburn would not go, no matter what I took for it. This was on my birthday, and I’d had too much to eat and drink! I Googled ‘heartburn’ and up popped ‘heart attack symptom’  - so I took an aspirin and went to hospital, where cardiologists implanted a stent in my LAD. During the previous few months before this day, however, I’d been aware of occasional palpitations, but I’d put it down to too much coffee and not enough sleep.”

Laura, age 40, USA: “I was asleep and my symptoms woke me up. I had several simultaneous symptoms, but the first one seemed to be chest pain in the centre-left, somewhat under my left breast area. I’d never felt anything like it, so sometimes it’s hard to describe – it wasn’t sharp or crushing or burning, more like a dull pressure. I also had pain down the inside of my left arm that radiated up into the left side of my jaw and my left ear. I was very overheated, and I felt like I was going to throw up. The nausea and overheating faded, but the pain – chest, arm, jaw – stayed. In hospital, I was diagnosed with a heart attack caused by SCAD – spontaneous coronary artery dissection, treated with six stents.”

Sulma, age 61, Mauritius: “The sequence of events is so vivid in my mind. Before my heart attack, I had had some shortness of breath after exertion, like going upstairs. My first big cardiac symptoms were a discomforting epigastric pain and a tightening chest pain that woke me up at 4 a.m. from my sleep. This gradually radiated down the left arm, a numbing sensation. I started sweating as the pain grew in intensity during my trip to the ER, which took about 25 minutes. I was restless every second, and the pain in my chest became unbearable and tight. These symptoms persisted until I was given an injection and rushed to the Cardiac Unit for angioplasty and one stent implanted in my LAD.  As it was placed, all the pain went away.”

Martie, age 46, USA: “There is a  lot of heart disease in my family. My first symptoms were heartburn that progressed to a pressure on my chest. The pressure got to a certain point, but did not get progressively worse.  I also had a strange aching feeling in my elbows. It was weird, like arthritis I think, that became worse with time. But the most prominent symptom I had, which did keep getting stronger and would not go away, was the little voice in my head telling me this was not normal. I wanted to mention this because it is my one piece of advice to all my friends:  ”Listen to that voice in your head!”    When we got to the ER, when staff heard that I had both chest pain and this odd pain in my elbows,  they took me right in quickly!  Even before my first obvious symptoms, I had noticed a dead tired, flu-like fatigue, “tired to the bone through and through” as I told my son.  I almost went home to bed after driving the kids to school (I would be dead now! I needed groceries first though!) My symptoms did change a bit – one would subside, and another would get worse. The only one that got  much worse was in the elbows!  I had to be air-lifted to a hospital with advanced cardiac care. Cardiologists there found a large unexpected arterial tear (SCAD: Spontaneous Coronary Artery Dissection) and repaired half of it with three stents. They left the other half to heal itself.  Three weeks later, they found that it had indeed healed.”

Sharon, age 43, New Zealand: “My heart attack started as I was walking across a flat lawn on my way to feed our goldfish. The pain struck out of the blue. I had no idea that a heart attack could present with pain in the back rather than the chest. My first symptom was a strong pain in between my shoulder blades, a lot like very bad indigestion but in my back instead of my tummy. A few minutes after the pain in my back started, I got very, very hot, then I felt nauseous. Then after several minutes, I felt the pain travel through into my centre chest, and then down my left arm to my hand. Like many others, that’s when I guessed that this might be serious. The pain kept increasing in my back until it was unbearable, but the other symptoms pretty much stayed the same until I was treated in hospital. Thank heavens for morphine – yay!  I was diagnosed with a heart attack caused by SCAD (Spontaneous Coronary Artery Dissection) of the LAD (Left Anterior Descending coronary artery). Two stents were implanted. They were tough days.”

Dawn, age 49, USA: “I was asleep and woke up not being able to breathe. I felt an ache in my left shoulder blade. My throat felt ‘full’ and my lips were numb. These symptoms came and went until I ended up in hospital and had four stents implanted. But even before that night, I’d been feeling extremely tired; I kept telling my hubby I wasn’t sick, but something was wrong. I never had any chest pain at all until six months AFTER my heart attack.”

Gloria, age 63, Canada: “I had a tremendous, dull, pressing pain in the centre of my chest, as if a walnut were being pushed into it.  I also had numbness in my right shoulder radiating down my arm and felt as if the arm suddenly became weighted. Later, the same symptoms were manifested in my left shoulder and arm. Chest pain stayed, but the numbness in both arms gradually went away. This was replaced with blinding pain in between my shoulder blades. Once started, the back pain only got worse. I could no longer sit, stand, lie down or walk around. The pain was so intense it took my breath away. I remember thinking that these were signs that you could be having a heart attack. These events took place between 4 p.m. on Christmas Eve 2007 and about 11:30 a.m. on Christmas Day, before I finally thought it was serious enough to get my son to drive me to our local  hospital. These just didn’t sound like the classic cardiac symptoms I had heard of. I lost conciousness while the ER doctor was trying to convince me it was a gallbladder attack and not a heart attack. It took three days to stabilize me before I could be flown to the cardiac centre in Victoria, where I had an angioplasty done with two stents implanted. The previous two months had been unbearably stressful. I would get out of breath walking, but I just put that down to steep hills in town. I had put on weight, and the week before the heart attack, for some reason I gained 10 pounds. Maybe someone will read this and decide not to wait as long as I did.”

Diane, USA, heart attack at age 33: “My first heart attack was 23 years ago but I remember it as though it were yesterday. I had just turned 33 the month before it happened. I put my 3-month old baby to sleep in her crib, checked on my older daughter and went to the living room to relax before heading to bed myself. My first symptom was like a fist in the center of my chest, pushing and squeezing to get out. The pain felt as though someone was gripping me inside right in the center of the sternum and squeezing until I could hardly breathe. My left arm hurt from the shoulder to the elbow, then stopped and picked up hurting at my wrist into my hand. I started feeling very sick to my stomach and vomited until there was nothing left, but still continued retching. I was sweating like crazy. I woke up my husband, and told him I thought I was having a heart attack, but not really believing that was happening because I had no clue what the symptoms of a heart attack were. While waiting for the ambulance, I went from abnormal sweating to freezing cold. In hospital, they diagnosed a 98% blockage of the LAD, which they did angioplasty for. I spent 15 days in hospital. I had just given birth three months prior, but even during the pregnancy and afterwards, I had been getting that same feeling in my chest off and on.  I had mentioned it to the ob/gyn but they told me that I had so much amniotic fluid that it was pushing my insides up into my chest and that was the cause of the feeling.

My second heart attack happened 10 years ago when I was 46. I was having ongoing problems with unstable angina so I had to have a stent implanted. The day after I came home from hospital, I walked into my living room and all of a sudden, I had this overwhelming feeling that something was terribly wrong. I told my husband to call 911. In hospital, they stabilized me and sent me to another hospital, where a cardiologist attempted to open up the new stent that had just been implanted. It had closed up, causing another heart attack. I went into cardiac arrest twice. I am now 56 and in need of bypass surgery for another blockage in the circumflex artery which they are unable to stent. Since I am not having symptoms, they are holding off on it, to my relief.”

Kathi, age 55, USA: “I awoke around 1:30 a.m. and felt pain down my right arm. It intensified as time went on, with the pain/tightness extending to my chest area. I had intense nausea and began vomiting and having bouts of rampant diarrhea in between. When I got to the hospital, the cardiologist found my LAD had collapsed without any coronary artery disease. While he was implanting two stents, he caused a hole in my artery, so had to put in a third stent. I believe that my heart attack was caused by stress and by an overdose of a variety of hormones prescribed for my chronic fatigue syndrome. Even before that night, I’d felt flu-ish with no energy, not unusual with CFS. I didn’t feel quite right, but I had no clue what it was and because I have CFS, I thought it may be related to that. One day, I noticed difficulty in getting my teeth to feel clean. All that day I felt like I needed to brush my teeth ( and did) but they wouldn’t feel clean like they always did when I brushed them. I am very aware of my body and what goes on with it.”

Monica, USA, heart attack at age 32: “One month prior to my heart attack, I was not feeling well with chest pains, lock jaw and fatigue. But my first real symptom was at 5 a.m. – pain in mid-chest radiating into my back and into my throat. I felt like I was being strangled, pain spreading into my throat and ears. The pain literally felt like 10,000 elephants sitting on my chest.  In the ER, because of my young age and the fact that I weighed only 100 pounds soaking wet, they thought I was a drug user. I was later told I’d had a massive heart attack.  I spent two days being stabilized before having a stent implanted, but instead of the stent, I was taken straight in for emergency bypass surgery. My heart now has severe damage to the left lower chamber. Last spring, 10 years after my heart attack, I had to go back into hospital to have an implantable cardiac defibrillator (ICD) put into my chest. I have named my ICD “Trigger”!

Allie, age 51, USA: “I’ve had two serious cardiac events with different symptoms for each one, so I’ll tell you both stories.  My first symptom in January was incredible fatigue. I was sitting in bed, watching TV and could suddenly no longer even hold my head up. The next day began six weeks of on-and-off symptoms of nausea, dizziness, back pain in my left shoulder blade (which eventually began to radiate through to my chest), profuse night sweats and feelings of being intolerably hot. I began having panic attacks (my first ever), feelings of doom, and severe anxiety. The back pain felt like a muscle knot. After a while, it seemed to hurt all the way through my body to my chest with that same soreness and knot feeling. My symptoms were not related to exertion. When I went to the hospital, I had to have emergency open heart surgery for a triple bypass.

But almost immediately after my bypass surgery, the bypass grafts began to fail. My chest pain this time felt sharp and pinching as if my clothes were too tight, then it moved up the left side of my neck. My throat felt full, and it was hard to swallow. My left jaw ached (like a dull toothache, or maybe having a piece of popcorn stuck). I also felt dizzy, hot, nauseated and anxious. Any activity or emotional stress brought on chest, neck and jaw pain, but other symptoms came on without any reason. These symptoms came and went for over two months and were ignored by my cardiologist because he said they were different than pre-bypass. Finally, I was correctly diagnosed and had two stents implanted to open the failed bypass grafts.  Two new blockages remain. I also have Peripheral Artery Disease (PAD) which is usually associated with coronary artery disease and strokes. I had symptoms of this even before my cardiac symptoms began – which I ignored.”

Misty, age 26, USA:     “I was  35 weeks pregnant and feeling really tired because we had just put up the new baby crib the night before. I went to sleep, but woke up to this weird constricting feeling in my lower throat, like I had a lump of something stuck there. The feeling went down to my upper chest and continued down to the lower chest area. It wasn’t pain, just more of a squeezing, restricting feeling. I then started to get a slight pain that felt like acid relux. I started to feel faint so I woke up my husband. I was sweating profusely, nauseated, had the chills and felt faint. And I also had a very weird tingling and numbness in BOTH arms from my shoulders to my elbows. We went to the hospital, where I was told that I’d had a massive heart attack caused by an aneurysm. It had exploded and made a tear in one of my heart valves, allowing blood to flow through the layers and squeeze the valve. The doctors say my body just couldn’t handle the stress of the pregnancy. I ended up having an emergency C-section and triple bypass surgery. I have also had an ICD (Implantable Cardiac Defibrillator) placed because my heart muscle has not healed the way they wanted it to.  But even before that day, I’d been feeling tired and short of breath, and I had just blamed it on being pregnant. Now I can see all these issues as cardiac problems and not just pregnancy.”

Joyce, age 60, USA: “My heart attack happened on the stress-treadmill in the cardiologist’s office.  He handed me a nitroglycerin tablet to put under my tongue. I had extreme shortness of breath but felt no pain that I remember. I had had some symptoms in the weeks before, such as tightness in the chest and extreme pain in my left shoulder blade. I also had these same symptoms months earlier, but dismissed them as just a pulled muscle after lifting heavy luggage. Even my doctor thought I had pleurisy or a virus, but sent my EKG ( with an unusual T-wave) to the cardiologist who wanted me to come in for the stress test. I was lucky to have my heart attack on the treadmill, because a subsequent angiogram showed no blockages, but a diagnosis of Prinzmetal’s Angina.”

Kim, age 52, USA: “I’d been feeling extremely tired for some time.  One day, I was putting the vacuum cleaner away, and suddenly felt as if I’d pulled a muscle in my chest, in the center of my sternum, like a tight, heavy pain.  I was sweating profusely and feeling nauseated. I had pain/tingling in my left arm, and then I blacked out. When the paramedics arrived, they gave me nitroglycerin which eased the symptoms temporarily. In hospital, I had to have two stents implanted and spent two days in ICU because of low blood pressure.”

Amy, age 28, USA:  “I had crushing chest pain while I was pregnant, along with sweating and nausea. I was told it was the baby kicking my diaphragm. These symptoms continued for two years, off and on, usually brought on by exertion. After pregnancy, I was told it was exercise-induced asthma, then pleurisy. Finally, after a bad episode (burning up and down my chest – like heartburn on steroids, sweating, nausea, vomiting, tingling in my arms and legs  - both sides, stabbing shoulder pain and shortness of breath) I was finally sent for a stress test, where heart attack damage was found. By this time, even walking across the room or watching something emotional on TV (like a Hallmark commercial!) would set off symptoms.  I was taken to hospital, but during my angiogram, I had a massive heart attack on the table. I had to be transferred to another hospital and had an emergency double bypass. **My unsolicited advice: don’t have an angio in a hospital that doesn’t also offer excellent open heart surgery. The balloon pump did quite a bit of damage to my arteries during the transfer.  Since those first undiagnosed cardiac symptoms at age 28, I’ve had a second heart attack and double bypass surgery at age 30, nine cardiac stents and three iliac artery stents implanted at 30 and 31, and then triple bypass surgery at age 31.”

Kimber, age 46, USA: “My first symptoms felt like a blow to the chest, like a shotgun smack dab in the middle of my chest. It immediately took my breath away and knocked me backwards about 3-4 feet. I also had an intense drilling pain under my left funny bone. The symptoms did not let up. At the time, I was just sitting at my desk.  Doctors found 0% plaque in my arteries – I was diagnosed with a coronary artery spasm from Prinzmetal’s Angina.  I remained several days at two different hospitals. My first heart attack was on May7th and my second was on May 22nd.”

Gill, age 49, UK
: “I had what I later found out was classic angina, severe tiredness and increasing chest pain, treated for all sorts of things, including inflammation of the sternum, but it got steadily worse over six months. I then had an angiogram that showed severe disease in two of my coronary arteries. I was treated with various medications over six months, but steadily worsened. Then doctors attempted a stent placement, which failed and I was sent home the same day with a small dissection (tear) which I was told would heal by itself. But two days after the dissection, while watching TV, I had increasingly unstable angina, unresponsive to nitroglycerin, with sweating and nausea. I went to the ER where I had a bigger heart attack, with crushing pain, pain radiating up into my throat and tongue, nausea, vomiting and sweating, plus pain in my left arm.  These symptoms came and went, in between different drugs they were giving me. A further angio showed that the dissection had not healed but extended, and the artery was full of blood clots. I was then sent immediately by ambulance with police escort to a cardiac unit a couple of counties away, where I had four stents implanted.  This did not cure the problem,  however, so two months ago I had to have double by pass surgery.”

Nancy, age 44, USA: “I believe I had SCAD (Spontaneous Coronary Artery Dissection) 10 years ago, but was misdiagnosed with costochondritis, 11 days postpartum. Two years ago on a Sunday afternoon, I had a strange spell of nausea, headache and faintness out of the blue - a combination of sick feelings that lasted a few minutes, and which struck me as unusual. I lay down and felt better. That was the day before more heart attack symptoms started after some heavy exertion, again due to SCAD. I think the artery must have torn a bit that Sunday, but it was not yet severe.

The next morning (my theory) the tear extended after physically demanding exertion, then I had the heart attack.I think this is important to clarify because one could conceiveably prevent the dangerous extenson of an arterial tear by avoiding exertion (if you’ve had the prior symptom of unusual faintness/nausea). Get medically checked out if you have that unsettling out-of-the-blue nausea/faintness feeling. Do not engage in physical exertion until cleared that your heart is ok.

I went to hospital with very painful central chest pressure, labored breathing, pain/numbness radiating to throat and arm, difficulty standing or talking. In the ER,  my blood tests showed elevated troponin cardiac enzymes (confirming heart attack, which the ER doc initially diagnosed as anxiety). I was taken to another hospital where the dissection was discovered and I received two stents. Two days later, two more stents were implanted for an intractable spasm of the left anterior descending coronary artery (LAD). The pressure and pain from the LAD spasm felt more life-threatening than my dissection, maybe because it was a bigger artery?

But even before those events, for some time I’d had non-pain angina symptoms like chest pressure and shortness of breath. I thought it was just from exertion or allergies. It felt like your chest and breathing might feel when you exercise in very cold weather. I’d also had spells of chest tightness when awakening, which I just attributed to anxiety because we had a child health crisis going on.”

Erna, age 49, USA: “Late one evening, I was working on a website for my son-in-law when I started having some pain in my right arm and thought that maybe I had worked my arm too much with the computer mouse. But the pain started radiating into my shoulder and after this into my back. There was no pain in my chest. I thought it was time to quit, and I did some meditation. I had no memory of anything else until the next morning, when I awoke and felt awful. I could not breathe, my back hurt, and I felt like throwing up but could not. The symptoms got steadily worse and I called 911.  The firefighters and paramedics who responded knew right away that it was a heart attack when they saw my EKG.  When we got to the ER, however, the doctor told the nurses to take the EKG leads off because I was just having a panic attack. But the paramedics were still there and they insisted that my leads be placed on again, and that’s when they saw my pulse flip-flopping on the monitor. I was sent by helicopter to a different hospital where I had three stents implanted. It was very scary.”

Corby, age 51, USA: “My first cardiac symptom was anxiety and pressure in the upper chest – I tried to dismiss it as indigestion. (I also ignored the pain in the back – even months before, generally when I was feeling stressed). I had swelling in the hands and feet, was out of breath climbing stairs – I thought it was just the cold air. These came and went. Then I had a squeezing feeling, pressure in the center of the chest and towards the left but still felt like severe indigestion. My head and arms broke out into a cold sweat and felt clammy. I had nausea and the ‘dry heaves’.  I was driving myself to work and decided to pull into the ER on the way. I had emergency bypass surgery for a blockage in my left anterior descending coronary artery (LAD) with a mammary artery graft.

This week, six years later, I just got out of the hospital again with a blood clot in my lung. I thought at first I was having another heart attack. The symptoms were crushing pain to the chest and numbness in the arm, a clammy feeling, cough, low grade temp. I am on blood thinners and they don’t know why this happened.”

Carolyn Thomas is a heart attack survivor who blogs at Heart Sisters.

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  • http://Www.twitter.com/alicearobertson Alice

    Prevention magazine has an article this month with similar stories. Apparently, some ER docs are just used to panic stricken women and assume wrongly, and some women do get tested right away. I had no idea that my gestational diabetes, and placenta previa put me at a much higher risk. I knew there was risk….but add my lack of sleep and I feel like a ticking time bomb.

    I found the list of doctors on the Prevention magazine board of interest, and the cardiologist interviewed is at the Clinic so we may change (the one we have now is flippant….he is older and you get the feeling he would rather be anywhere but there).

    Many articles rightfully, recommend exercise, but lady in the article needed 10 to 12 hours of sleep. It is good we can share information like this.

  • http://www.myheartsisters.org Carolyn Thomas

    “…I had no idea that my gestational diabetes, and placenta previa put me at a much higher risk…”

    Alice, there’s some very interesting research published last year in the American Journal of Obstetrics & Gynecology by Dr. Graeme Smith of Queen’s University about the strong link between cardiovascular disease and pregnancy complications like yours (plus pre-eclampsia, pre-term birth, abruption and others). Women with such complications of pregnancy may in fact be 2-3 times more at risk of heart disease than their uneventful-pregnancy counterparts. More on this at: http://myheartsisters.org/2010/12/12/pre-eclampsia-link-heart-disease/

    When I had my heart attack, cardiologists asked me if I were a smoker and if I’d been treated for diabetes, high blood pressure, high cholesterol and other CVD risk factors – but not one person asked about my pre-eclampsia during my first pregnancy.

  • Mary

    (Age 56) Thank you for posting this article as it provides and invaluable service to many women who doubt themselves. It’s apparent how much bias there is in the medical profession, to deny that women can be having cardiac events during their reproductive years. Although I have been fortunate to not *yet* have an MI, my endothelial dysfunction – microvascular disease (this means there are no occlusions found when the angiogram is performed with special chemical “challenges”, they can see the vessels are behaving OPPOSITE to how they are supposed to behave; I live with sensations that almost every day, sometimes many times a day, FEEL as though I am actually having a heart attack. This has been happening since I was in my early 40s. This makes for many false alarms. But, they need monitoring and treatment (especially nitroglyerin) and management, and I still need to notice when some symptoms change, as MIs can be provoked by ischemia (diminished blood flow to heart muscle).

    Thank you for posting these concise summaries of real women’s real experiences. To a healthier and happier New Year! ~

    • http://inspire.com donna

      Mary, I am sorry you had to go through this. thanks for telling your story.
      I imagine Did thye have you do all the standard tests in between that cost money and showed nothing.? like stress teeadmill with echo? I had an echo and didn’t do the treadmill…… also wore the holter. which showed irregularity….women doctor said not dangerous.
      I have sensations every day and that’swhy my naturopathic doc and 4 other doctors say well you’re still here. am waiting for 30 blood results on jan10 just praying no snow ice because it stresses me out worse with the hour drive to the doctor.

  • http://www.myheartsisters.org Carolyn Thomas

    Thanks Mary for bringing up your diagnosis of coronary microvascular disease. Until very recently, as you know, non-obstructive cardiovascular disease in women has been routinely misdiagnosed because conventional cardiac diagnostic tools don’t pick it up, despite our ongoing life-limiting symptoms. Mayo Clinic has useful info on this often-missed Dx: http://www.mayoclinic.com/health/small-vessel-disease/DS01080

    • http://inspire.com donna

      dear carolyn thank you for sharing your story. on inspire.com or org there is a women who went to mayo thank you for this link, my gf lives in AZ and wants me to come there to mayo. stress of traveling myself and leaving my cats would be too much. thank you again.

  • Campykid

    There is a not-uncommon thread in Ms. Thomas’s post of doctors dismissing women as having anxiety attacks when the symptoms were actually heart-related. Luckily, my heart is structurally fine, however, I went through 10 years of trying to convince several doctors that chest pain, shortness of breath, and palpitations were not due to panic attacks. Finally, my atrial fibrillation was so bad it was captured on a 24 hr Holter monitor. Moral of the story: your body is wise-listen to it!

    • http://www.myheartsisters.org Carolyn Thomas

      Campykid, 10 years of being dismissed is almost worse than enduring the initial symptoms! “Listen to your body” is sound advice for all.

  • http://doctorstevenpark.com Steven Park, MD

    Wow! I was riveted while I read through the entire post. We know that younger women can have heart attacks, and it’s acknowledged that doctors are not good at picking up heart attack symptoms in younger women.

    Here are a few observations that I had:

    1. Many of the women had heart attacks from 3-5 AM. One study showed that people with obstructive sleep apnea have heart attacks during this timeframe, as compared to earlier in the morning in people who don’t have sleep apnea and have heart attacks.

    2. Many women also described severe heartburn as a major symptom. If these women were having a sudden increase in the number and severity of apneas, then it’s expected to have more severe reflux, due to the negative pressures in the chest. One woman, Lidia, had too much to eat and drink for her birthday. Alcohol relaxes your throat muscles, and additional reflux from stomach juices can cause more obstructions and arousals.

    3. One woman described recent 10 pounds weight gain—an additional risk for obstructive sleep apnea.

    4. Also notice how many women either were pregnant or post-partum. Weight gain during pregnancy is a major risk for obstructive sleep apnea, which can lead to pre-eclampsia and gestational diabetes. That’s also why pregnancy complications are linked to a higher rate of heart disease—because you’re at risk for having obstructive sleep apnea. Post-partum, the protective effect of progesterone is gone (progesterone tenses your upper airway dilators), and more frequent breathing pauses can tip you over the edge.

    5. I’m willing to bet that many of these women snored, but it’s also been shown that you can be young, thin and not snore to have significant obstructive sleep apnea. What I’m sure of is that one or both parents of these women snores heavily, with major cardiovascular disease. Typically, these women won’t be able to sleep on their backs, due to smaller oral cavity jaw structures, which narrows the posterior airway space. Deep sleep will relax the muscles, making them more prone to breathing pauses.

    6. Some of the women also mentioned casually that they were sleep deprived. Not sleeping enough can be a major trigger to cause major sympathetic stimulation when normally, you’re not ever able to get efficient sleep at all.

    7. I bet that most of these women, even when younger, never felt refreshed, no matter how long they slept. Typically, these women will attribute their fatigue to anemia, stress, TMJ, sinus infections, migraines, hypothyroidism, insomnia or chronic fatigue. Many will also have cold hands or feet, and oftentimes, blood pressure will be one the low side, especially when younger (later on, the BP normalizes and then goes high). This is called upper airway resistance syndrome, a variation of obstructive sleep apnea, where you can stop breathing 10 to 20 times per hours and not have official sleep apnea on a sleep study.

    It’s important to pick up the atypical symptoms of heart attack in women, but what’s just as important is to treat what’s actually aggravating, if not causing the heart disease. If this had been done months or years prior to their heart attacks, many of these cardiac events could have been prevented.

    In these women, there was usually some trigger that tipped them over the edge, whether it’s weight gain, eating late, severe stress, drinking alcohol, pregnancy, or even weather changes. There’s so much proven evidence showing that most people with heart disease have (or will have) significant obstructive sleep apnea. Physicians have to erase the image of the traditional sleep apnea patient as being overweight, snoring, male, with a big neck. Sleep apnea is a craniofacial, anatomic problem due to smaller jaws. Obesity comes later, which only makes the problem worse.


  • Roger V.

    Dr. Park’s wise words should be heeded by the medical profession. Regular screening of all patients for sleep-disordered breathing will have a major impact toward reducing heart attacks. Screening should be done by a health professional with interview skills who is trained in specific techniques of questionnaire screening and observation of facial structure, teeth, tongue, soft palate, tonsils, and adenoids. This is a very easy, quick and inexpensive screening.

    • http://www.myheartsisters.org Carolyn Thomas

      Roger, are you recommending this screening for ALL patients as part of a routine physical exam?

  • http://www.myheartsisters.org Carolyn Thomas

    Thanks Dr. Park for your very detailed response to my post.

    “..doctors are not good at picking up heart attack symptoms in younger women…”

    Sadly, this continues to be true. The New England Journal of Medicine reported on a study of more than 10,000 patients (48% women) who went to their hospital Emergency Departments with heart attack symptoms. Researchers found that women younger than 55 were SEVEN TIMES more likely to be misdiagnosed than men of the same age. The consequences of this were enormous: being sent home from the hospital in mid-heart attack doubled the chances of dying.

    It’s alarmingly common for women to be told, as I was during my heart attack, that they’re merely suffering from indigestion. Others are sent home from the E.R. misdiagnosed with anxiety, gall bladder problems, or menopause (a lovely all-purpose diagnosis!)

    Many of the heart attack survivors I know also report trouble sleeping; some are now finally being appropriately treated by sleep specialists like yourself, but it’s long AFTER the fact, as you say. Perhaps as you claim, many of these cardiac events could have been headed off years earlier if we looked at sleep as an integral part of our overall health.

    With your permission, I’d like to quote your comments on HEART SISTERS.

    • http://doctorstevenpark.com Steven Park, MD

      Carolyn, yes you have my permission to quote me.

  • Mary

    (Endo Dysfuntion / MVD/ ischemia poster here, 56): I can validate the issues re: apnea. In my own case, I had more hypopnea (shallow breathing…low oxygen saturation – at times 72%) vs apnea. Yes, my father had severe untreated apnea. Yes, he carried extra weight (a lot) and I do (appx 30-40 lbs), BUT, my nasal airway is severely reduced on the left and smaller than average on the right. Surgical intervention may not fix.

    I had an INADEQUATE take home sleep study at an HMO, and we never found the right combo of CPAP machine/mask as the efforts were limited (yes, due to TMJ).

    Subsequent lab study revealed zero stage 3&4 sleep, so yes, reason for exhaustion. Yes, a chronically over-activated sympathetic state. (Note on this at the end)

    However, there are multiple factors that can lead to risk, and two hidden lipid factors that were not discovered till seeing the female focused cardiologist: elevated Lp(a) and VLDL3 (primarily genetic). All my superficial LDL, HDL, TRI looked very good, as did my BP. Incidentally, extremely low D levels which is postulated to add to risk. So you need an inquisitive and thorough doctor who steps back, looks at the big picture, and does not fall back to the “easy” reply, such as GI (yes, hiatal hernia as do 50% of population). In the case of board certified sleep medicine, you need a PATIENT and creative team who continue to work with you to find a system that works. Compliance is everything – if you don’t use it, it can’t help save your life. One of my female cousins, age 42, died in her sleep. Sleep issues are not benign.

    RE: chronically over-activated sympathetic state. As I am married to a psychologist, I was aware that childhood abuse (emotional and physical) remained unresolved. Additionally, the chest pain and SOB was so misdiagnosed as anxiety and GI, I was in constant fear of dying. I did almost 30 sessions of EMDR (an excellent treatment for residual trauma of any kind) and it diminished the elevated sympathetic state and chest pain perception (ischemia/SOB is still there), HOWEVER, it was not strictly apnea OR lipids OR anxiety: The body is a full system and epi-genetically triggered (life and behavior interacts with genes). There is sometimes a singular AHA! reason, but sometimes, there can be a constellation of issues to address.

    • http://www.myheartsisters.org Carolyn Thomas

      I agree, Mary. Heart attack is “not strictly apnea or lipids or anxiety”.

      When a terrifying cardiac event strikes, the first question is often: “Why? Why? How could this have happened to ME, of all people?” We look for, demand, and need some kind of neat and tidy gift-wrapped answer to the puzzle. We re-examine our mother’s cardiac history, our borderline-high BP, that stressful time at work, the few extra pounds we’ve been meaning to shed. But each risk factor may or may not have anything to do with our heart condition.

      Consider the French, who smoke more, exercise less, eat more trans fats, and consume only slightly more fruit and veggies than the Brits do, but have the lowest cardiovascular death rate in the European Union – only about one-quarter of the British rate. This is the notorious “French Paradox“ of those Gauloises-smoking, double-cream brie-eating citizens.

      Perhaps the French are better sleepers? What do you think, Dr. Park? Any thoughts on this paradox?

      • http://doctorstevenpark.com Steven Park, MD

        I agree there are so many variables that are involved when it comes to heart disease, and unfortunately, modern medicine tries to reduce it down to one variable. I have to admit, I’m guilty of it myself. However, the way I justify emphasizing sleep as a major culprit that’s not addressed is because breathing is THE MOST fundamental process you have to do to not only survive, but to thrive. Most doctors (allopathic and complementary/alternative) still believe that most people are able to breathe properly while sleeping, and that sleep apnea is something that only certain older, heavy-set snoring men with big necks have. This couldn’t be further from the truth. We know that young, thin women can have not only numerous apneas, but just as many non-apneic breathing pauses. These shorter obstructions still will keep waking you up from deep sleep to light sleep, without it showing up as an apnea.

        I argue in my blog, articles and my book that all modern humans are susceptible to breathing problems at night to various degrees, and only the end extreme of this spectrum is called obstructive sleep apnea. Interrupted breathing leads to interrupted deep sleep, which causes a massive physiologic stress response, which heightens your nervous and immune systems.

        Yes, being overweight can aggravate these problems, but the root cause is due to under-developed jaws, with narrowing of our entire upper airways, from your nose to your voice box area. Recent modern changes in our diets and modern technologies are making things worse. The additional inflammation that arises (within your airways and your body) narrows the upper airway even further, causing more obstructions. Over time, poor sleep causes hormonal and metabolic changes that promote weight gain (which narrows the throat even more).

        Various other factors can aggravate or prolong this vicious cycle: allergies, weather changes, certain foods, sleep position, nasal congestion, reflux, colds, viral infections, etc.

        It’s funny you mention the French. Every time a study comes out that touts the benefits of drinking wine, I get a rash of patients with sleep problems, headaches, migraines, throat pain, sinus infections, and gastro-intestitnal symptoms. These studies generally show positive results in only the French, since their lifestyle and culture is very different. In the US, we’re much more stressed in general, with poor eating habits, and more likely to binge drink, or eat and drink later into the night. Baboon studies by Dr. Robert Sapolsky (Why Zebras Don’t Get Ulcers) show that psychological stress itself can cause massive inflammation and heart disease.

        My point is that if we could routinely screen for sleep breathing problems with simple questionnaires, the rates of heart attacks will go down significantly. Even if treating sleep-breathing problems prevent 10% of all heart attacks, that’s still a lot of lives that can be saved. Numerous studies show that untreated sleep apnea is a major risk factor for heart attack, stroke, and sudden death. Despite all this knowledge, we haven’t applied it fully so far.


  • Roger V.

    “Carolyn Thomas posted: Roger, are you recommending this screening for ALL patients as part of a routine physical exam?”

    Yes, Dr. Park originally brought up this issue in his blog. I look at the cost/benefit ratio. The cost of the first screening is low. If the patient screens negative because he has a well-developed jaw, a full set of uncrowded teeth, and no other symptoms of sleep-disordered breathing, this can be noted in his medical records and subsequent screenings can be even shorter, quicker, less expensive. For those who screen positive there is a big issue with the cost of in-lab PSGs. However, portable equipment for patient-managed home studies is becoming more popular and it is lowering costs dramatically.

    Then there is the benefit side of the equation. It is believed that maybe 90% of all patients with SDB at a severity level that justifies treatment are undiagnosed. We also know that years of no treatment result in many cases of heart disease, type 2 diabetes, obesity, anxiety, depression, ADD, and symptoms of dementia. So widespread screening that leads to diagnosis and treatment can have a huge benefit to society in terms of productivity and medical cost savings.

    The healthy heart is a wonderful creation that can pump efficiently and strongly for more than one hundred years. But when it is put under huge all-night stress from SDB for years, it will prematurely cease to be healthy.

    As you stated, women (anyone actually) needs to know the symptoms of heart attack and take action. But years before the heart attack, we should all know the symptoms of SDB and take action which can prevent heart disease and many other severe health conditions.

  • Roger V.

    Mary brings up the subject of ” a chronically over-activated sympathetic state” and “childhood abuse (emotional and physical) remained unresolved.”

    I think there is something to be learned on this subject from studies the Army is doing on PTSD and sleep apnea. Quoting from one article, “Despite their relatively young age (around 35) and slightly overweight physique, 54% of the PTSD patients who underwent polysomnography at Walter Reed were diagnosed with obstructive sleep apnea (OSA) — whereas, in the general population, the rate of OSA is only 20%. ” http://www.medpagetoday.com/MeetingCoverage/CHEST/23074

    Fifteen years ago the Army believed that PTSD was causing sleep apnea and many veterans receive disability benefits today because of that assumption. I am sure the Army will very soon conclude that people with sleep apnea are much more highly susceptible to PTSD. Sleep apnea (or other forms of SDB) are causal factors in PTSD and not the other way around.

    I also believe people with SDB are far more likely to suffer psychologically from childhood traumas. Reversing the statement, people who have healthy breathing while asleep are much less likely to suffer from similar childhood traumas.

    I had a lengthy discussion with a psychotherapist about women in their childbearing years who suddenly for the first time start suffering from sexual abuse inflicted upon them as children. I asked why would they go many years without problems and then it suddenly appears. The answer was we are not sure but we believe having a child the age they were when abused brings out repressed memories.

    This could be true but I believe there is another possibility that is more likely. As Dr. Park has pointed out hormonal changes and weight increase may bring on SDB or make an existing case worse. This is often happening to women in their childbearing years. So I highly suspect that these women suddenly suffering from memories of childhood abuse have developed SDB which is causing a chronically over-activated sympathetic state and bringing the memories and problems to the forefront.

    This all points back to the claim that the GP and the patient should be continuously aware throughout the life of the patient of any symptoms of SDB and take appropriate action.

  • http://www.myheartsisters.org Carolyn Thomas

    Thanks Roger,

    “…sleep apnea (or other forms of SDB) are causal factors in PTSD and not the other way around…”

    Intriguing example of the chicken and egg question: which comes first? The sleep problems or the PTSD?

    We’re seeing a similar question re pregnancy complications, about which researchers like Dr. Graeme Smith are now suggesting that pre-eclampsia, for example, is linked to a 3-4 fold increase in heart attack risk. But this serious condition doesn’t CAUSE heart disease – it merely REVEALS it, sometimes decades in advance of a diagnosable cardiac event.

    Similar findings are emerging about the commonly believed link between physical exertion and heart attack, disputing the assumption that it’s all that snow shovelling that caused Grandpa to have his heart attack. But as cardiologist Dr. Sharonne Hayes of Mayo Clinic claims: ““All heart attack patients have had an underlying condition that caused the attack. Most heart attacks, in fact, are 20-30 years in the making. About half of all heart attack survivors, however, mistakenly blame the attack on one specific event—such as extreme exertion.” More on this at:

  • http://a-changeofheart.blogspot.com/ Laura

    I’m the 40-year-old idiopathic SCAD patient (not pregnant, nor just post-partum).

    I’d had the overnight sleep study to test for sleep apnea about 15 months prior to my heart attack and it was negative for apnea. I’d also lost about 25 pounds already before my heart attack and was in fact training for a triathlon (I’d ridden my bike about 2 miles the day before the heart attack).

    I don’t smoke, am not diabetic, don’t have high blood pressure, and don’t have clogged arteries–and the docs should know, they looked at them twice from the inside. And I was already exercising and eating well.

    Now it seems I need to add “tested negative for sleep apnea, too!” just so everyone–doctors and other medical professionals as well as laypeople–will stop looking at me as if it were my fault that my artery dissected.

    Sometimes heart attacks just happen, and the person didn’t do anything to cause it.

    • http://www.myheartsisters.org Carolyn Thomas

      Hi Laura – just to help clarify your comment for other readers, here’s your story as you related on this post:

      “LAURA, age 40, USA: “I was asleep and my symptoms woke me up. I had several simultaneous symptoms, but the first one seemed to be chest pain in the centre-left, somewhat under my left breast area. I’d never felt anything like it, so sometimes it’s hard to describe – it wasn’t sharp or crushing or burning, more like a dull pressure. I also had pain down the inside of my left arm that radiated up into the left side of my jaw and my left ear. I was very overheated, and I felt like I was going to throw up. The nausea and overheating faded, but the pain – chest, arm, jaw – stayed. In hospital, I was diagnosed with a heart attack caused by SCAD – spontaneous coronary artery dissection, treated with six stents.”

      Thanks so much for contributing your own experience here – and also for your insights on the “why?” question we all face after a cardiac event, particularly after something like SCAD – which typically affects young healthy women with very few cardiac risk factors.

      We tend to look for something to blame after such catastrophic events. Yours is a good example of how futile that search can sometimes be.

      There is no one-size-fits-all explanation of heart disease.

  • Sue

    The comments are so interesting! My story seems different so I thought I would share. I’m 56 yrs. old. I had my heart attack at 54. I awoke about midnight with an elephant sitting on my chest, I thought. The pressure and inability to breathe was overwhelming but there was no pain involved. I was very light headed and nauseated. I went to the ER where they monitored me for a couple hours and then told me to go see my doctor because I didn’t appear to be having a heart episode. What was discovered was that I had indeed had a heart attack but my arteries are very tiny. In fact, the heart surgeon told me I am not a candidate for stents or bypass. I am being treated aggressively with meds.

    • http://www.myheartsisters.org Carolyn Thomas

      Hi Sue and thanks so much for sharing your story.

      Small vessel heart disease is tough to diagnose – and as you found out, these arteries are too small to stent or bypass. My own microvascular disease chest pain is being treated with meds as yours is, but now also with the portable TENS machine I wear on my belt all day long. It’s a non-invasive, non-drug therapy that I’m happy to say has significantly reduced my nitroglycerin use. More on this at “My Love-Hate Relationship With My Little Black Box” at HEART SISTERS – http://myheartsisters.org/2010/08/26/tens-for-chest-pain/

      Specialists at the Pain Clinic have also discussed a future invasive option called Spinal Cord Stimulator Implant should the TENS unit fail to provide adequate chest pain management over time. He has done a 2-year fellowship in Sweden where this procedure is commonly performed to address inoperable coronary microvascular disease pain in heart patients (rare in the U.S.)

  • http://www.stjohndublin.ie Gabriel

    Thank you, Carolyn and all those who contributed to this article. I’m a member of a local first aid and ambulance unit here in Dublin, and we often use roleplay during our training, but thinking back about it now, we tend to act out heart attacks according to the the ‘textbook’ way: crushing central chest pain, radiating down the arm, etc. If it’s OK with you I’d like to use some of these stories as scenarios to make things more realistic.

    • http://www.myheartsisters.org Carolyn Thomas

      Gabriel, you have just made my day! I would absolutely love it if you could somehow incorporate our stories of women’s real-life heart attack symptoms into your training programmes. Good luck to you and your team!

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