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Philip Plein RTW Spring 2014
Cardiac distress symptoms in women
In the wake of Carrie Fisherās death four days after she suffered a massive heart attack, one thing that was reported by some news outlets was that she had been in āsignificant distressā on the flight. We donāt know the exact details of this, but in my experience as an EMT, it often means āhysterical woman having a panic attack and thinking sheās dyingā¦*woman dies* ā¦oops, guess she really was dying.āĀ
It is SO IMPORTANT to remember that many women present in what medicine considers an āatypicalā manner for heart attack, but it actually IS typicalā¦for women. Women are more than twice as likely to die from cardiac emergencies, not because our physiology is that much different than men and thus gives us a worse chance at survival (itās actually better if treated promptly and adequately), but because our symptoms are more likely to go unrecognized or to be dismissed entirely.
Thus, please take a moment to review and pass on this list of cardiac distress symptoms as seen in women:Ā
Shortness of breath - This is the most common one. If a woman, especially one without prior history of respiratory issues or shortness of breath, seems to be having trouble catching her breath and/or complains of such, pay very close attention. If she continues to feel winded after sitting or laying down, itās probably time to call for help.
Feeling of impending doom - This can range from a sense of general unease to a full-blown panic attack. This one is extremely important, and is the symptom most commonly disregarded by doctors and hospital staff. If a woman tells you that she feels ānot quite right,ā or like something terrible is about to happen, or that sheās about to die, LISTEN TO HER FFS.Ā
Nausea and āindigestionā - Also common. Heart attacks frequently present as a feeling of vague nausea or indigestion, but unlike typical heartburn, antacids and other OTC treatments will not alleviate the symptoms.
Hiccups - Unexplained hiccups, especially if seen with any of the other symptoms listed above, can be indicative of heart muscle that is being acutely or chronically starved of oxygen. Ā The exact mechanism isnāt known, but itās thought that the enzymes released by the dying muscle irritate the pericardium and adjacent diaphragm, causing spasms in the healthy muscle.Ā
Fatigue - This is another commonly seen symptom, and is often overlooked or ignored as just transient tiredness. Many women having a heart attack will complain of feeling āflu-likeā symptoms of nausea, sweating, fatigue, and shortness of breath, and theyāll lie down for a nap and never wake up.Ā
Lightheadedness - A feeling of being lightheaded or about to faint isnāt terribly uncommon in many benign conditions, and many women experience it on a monthly basis. However - be aware when it appears unexpectedly or unexplainedly, and/or with one or more of the other symptoms on this list.Ā
Sweating (diaphoresis) - Heart attack does funny things to the sympathetic nervous system, which is behind reflexes such as sweating and hiccups. If a lady is experiencing unexplained or excessive sweating, pay attention to anything else that might be going on with her.Ā
Tingling or numb extremities - A feeling of numbness or āpins and needlesā tingling in the extremities can be an important sign that cardiac function is being impaired and those body parts arenāt receiving enough oxygen.Ā
Peripheral and/or central cyanosis - Often accompanies tingling or numbness, and is considered a later-stage symptom of cardiac distress and heart failure. Finger and toe tips will turn pale or blue first, and lips and gums after that. Important to remember that darker-skinned women may present cyanosis as ashen, grey, or darker purple rather than pale or blue.Ā
Back pain - Pain between the shoulder blades, in the cervical spine, or even further down in the torso or lumbar region can be a symptom of heart attack. Alone, it isnāt that suspicious, but if itās unrelenting and presents with any of the other symptoms above, keep a watchful eye on things.Ā
Classic ācrushingā or ātightā chest pain or pressure - Women DO experience this classic pain, too, just not as frequently as men do. This may be due to our higher pain threshold, or differences in blood volume, or maybe weāre just not sure because nobodyās bothered to really study it. Whatever the reason, some women do still experience the crushing or tightening pain, and others may experience less painful pressure or tightness that doesnāt seem to be relieved by anything.
Arm and jaw pain - Another āclassicā heart attack symptom, and a bit more common than central chest pain. Unexplained pain in the left arm or shoulder, and on the left side of the neck or jaw, should not be ignored by anyone.
This is so, so important.
All too frequently, cardiac events in women are misdiagnosed for the reasons listed above, but also because we live in a culture where womenās complaints are simply not taken seriously. Unfortunately, the medical community is no exception.
Ladies, YOU MUST BE YOUR OWN ADVOCATES. You know your bodies- do not let a doctor or nurse dismiss your symptoms as āhysteriaā. Demand thorough treatment, and if you find yourself in a position where you are being brushed aside, find a second opinion.
As a woman who was diagnosed young with heart disease (48), I can verify the above; be ready to fight to be taken seriously, because you may have to, unfortunately. My female cardiologist believed me immediately, but the damned receptionist had tried to gatekeep me out of an initial appointment, and none of the male cardios Iāve been to since have been nearly as ready to listen. Consider taking a male family member with you to advocate for you with a male doctor (who may well be more willing believe another manās reported observations of you than your own self-reported symptomsāI wish that wasnāt likely to be true, but trust me, it is). Get any cardiac symptoms checked out before you ever get to the attack stage, and donāt be fobbed off with just a stress testāthose are notoriously not as accurate for women.
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