Heart Attack Signs May Be Missed by Younger Women

Many younger women ignore or simply do not recognize the warning signs of a heart attack, often because it does not resemble the typical "Hollywood heart attack," say authors of a study presented at a recent American Heart Association (AHA) meeting.

"So many women said, 'We wish we had a better stereotype, you never see anything in the media,'" says study author Judith Lichtman, Ph.D., at Yale School of Medicine. "I personally would love to see some cutting-edge TV series of, for example, a young person having a heart attack with atypical symptoms."

Dr. Suzanne Steinbaum, at Lenox Hill Hospital in New York City, adds, "The classic image of someone having a heart attack is someone like John Belushi. It's a heavy man clutching his chest. We never think of young women as having heart disease, so the image is not part of their consciousness.

"It's so important that we not only tell women that heart disease doesn't necessarily have to look like [a Hollywood script], but they have to understand what makes them at risk," says Dr. Steinbaum.

Only 50 Percent Sought Care in First Hour

Heart disease is the leading cause of death of American women, claiming almost half a million lives a year, or about one death per minute. About 16,000 young women with heart disease die every year and 40,000 are hospitalized.

Last year, a study from the same group of researchers found that women under the age of 55 often fail to recognize the symptoms of a heart attack until it is too late.

Eighty-eight percent of women in that clinical trial reported traditional symptoms of severe chest pain. Yet only 42 percent suspected something was wrong with their heart.

Only half of the women experiencing heart attack symptoms sought care within the first hour, apparently because they thought their symptoms were not real or were not serious.

For this study, researchers conducted in-depth interviews with 30 women ages 55 and older a week after they had been discharged from the hospital following a heart attack.

Many did not realize the symptoms were due to a heart attack. For example, one woman said she was told she was experiencing symptoms of acid reflux. Others attributed symptoms to fatigue, overexertion, or stress.

Often, the symptoms just did not line up with how heart attacks are presented in the popular media.

"I [had] probably seen a show or something with somebody having a heart attack," says one woman. "And they fall. They grab their chest. And then they grab their arm... I mean, you don't see anybody saying I have pain in my jaw or especially a heart attack, you don't see them vomiting . . . I did not know that and it's probably because of television, I would say is why I thought it would just be in the chest."

Similarly, another woman told investigators, "It's like... I didn't have any of the typical heart attack symptoms that you always hear about on TV and the ER hospital shows."

Some delayed treatment because symptoms went away for a while, or because they were too busy or had experienced prior, negative encounters with the health-care system.

One woman said she called her physician about chest pains but was scheduled for a regular appointment in five days.

"A lot of women were triaged for a regular visit or, even in the ER, were being looked up for a lot of things other than a heart attack," says Dr. Lichtman.

Know Your Risks and Symptoms

Ironically, for some women, it was actually a relief to know that they were having a heart attack, that finally the mystery was over, says Dr. Lichtman.

Dr. Lichtman and her colleagues will be looking at this issue in more depth in a National Institutes of Health (NIH)-funded study enrolling 2,000 women under 55 and 1,000 men in the same age range.

"A little bit of empowerment goes a long way," notes Dr. Steinbaum. "Knowing your risk and knowing the potential for heart disease, seeking early care for symptoms that are really unclear and then saying, 'I am at risk for heart disease, please help me' becomes important in the paradigm of how this needs to develop."

Always consult your physician for more information.