Heart attack in women: how to recognize the signs

Heart attack is a common and serious medical condition. In Germany, it is the second leading cause of death and is accordingly feared. Even if, according to statistics, fewer women than men are affected, a heart attack is by no means a “male disease”. Early detection and rapid therapy are essential for a good prognosis. The most well-known signs of a heart attack include chest pain, weakness and profuse sweating with cold skin. In women, however, a heart attack often manifests itself with atypical symptoms, which is why many of those affected do not correctly interpret the symptoms. Here, we explain how to recognize a heart attack in women and what to do.

Heart attack: what is it?

A heart attack is an insufficient oxygen supply to the heart muscle tissue. Thrombotic vascular occlusions mainly cause this undersupply. This means that one or more arteries supplying the heart with oxygen-rich blood are extremely constricted or even entirely blocked by coagulated blood, so little or no blood can reach the heart muscle.

As a result of the undersupply, the affected tissue becomes necrotic. So, it will die if the oxygen supply is not restored quickly. A scar forms on the affected area. This scarred area can permanently no longer participate in the heart’s pumping function. As a result, cardiac insufficiency can develop.

The size of the damaged part of the heart depends on the location of the occlusion and the time until the start of therapy. In the case of a minor heart attack, for example, in which only a tiny artery is blocked, the consequential damage is often less pronounced.

In most cases, the cause of a heart attack is coronary artery disease. Here, the vessels are slowly and progressively narrowed by calcification. A heart attack occurs, among other things, when these calcifications loosen (e.g. during heavy exertion) and activate blood clotting.

 

What are the first signs of a heart attack in women?

Angina pectoris is an early warning sign of a heart attack in both women and men. Angina pectoris is a dull pain behind the breastbone that is often accompanied by a feeling of pressure or tightness in the chest. It is caused by physical exertion or stress.

Angina pectoris is an early sign of a lack of oxygen supply due to coronary artery disease with narrowing of the vessels, which can escalate into a heart attack. This is a harbinger of a heart attack.

How do you recognize a heart attack?

A typical first sign of a heart attack in both sexes is more muscular pain behind the breastbone than in angina pectoris, which is perceived as devastating. This pain can often radiate. Radiation into the left shoulder and the left arm is classic. The pain can also be felt on the right side, stomach, back or neck. In addition, a heart attack is usually accompanied by fear of death.

The following symptoms can also occur at the same time:

• Rapid heartbeat or very rapid pulse
• feeling weak
• profuse sweating with cold skin
• paleness
• nausea
• limitations of consciousness

 

How does a heart attack manifest itself in women?

These warning signs occur in both men and women. However, atypical symptoms are more common in women. Women often suffer from pain that is not primarily in the chest. Women often report pain in the upper abdomen, upper back, arms, jaw, and neck.

Increased tiredness, shortness of breath, gastrointestinal complaints such as vomiting and diarrhoea and cardiac arrest are more common in women than in men. The symptoms can also be significantly less severe than in men.

What to do if you suspect a heart attack?

It is essential to recognize the complaints and take them seriously. It is important to seek medical help as soon as possible. Driving to the clinic yourself is not advisable. In the event of an acute heart attack, life-threatening complications can occur, which an ambulance service can deal with quickly and professionally.

Due to the atypical symptoms, women often tend to wait until late to call the emergency services. This significantly worsens the further course. The quicker a heart attack is recognized and treated, the less heart muscle tissue remains permanently damaged.

Contrary to the rumours circulating online, coughing does not help against a heart attack.

Tests for suspected heart attack

To diagnose a heart attack, the doctor will first perform a physical exam and listen to the heart. 

An electrocardiogram  (ECG) is then performed. The ECG records the excitation currents that cause the heart to beat. The ECG can – but does not have to – be changed and can already indicate where the vascular occlusion is.

A blood analysis helps with an ambiguous ECG and allows conclusions to be drawn about the course of the infarction over time. Substances detectable in the blood that indicate a heart attack include troponin, myoglobin and creatine kinases.

Other clinical pictures that damage the heart can also cause similar diagnostic images, such as heart muscle inflammation (myocarditis). However, the examining doctor can usually tell the difference between myocarditis and a heart attack in the electrocardiogram and the blood test . An ultrasound scan and an X-ray can also help distinguish between heart muscle inflammation and a heart attack.

In addition, heart muscle inflammation can be caused by other diseases (e.g. rheumatoid arthritis or radiation for cancer). In the presence of these diseases, it is essential to think of myocarditis when the symptoms of a heart attack are present. If, despite all the examinations, it is unclear whether it is a heart attack, a heart catheter examination is carried out, which serves to treat the heart attack.

 

treatment of heart attack

The exact treatment of the heart attack depends on the symptoms that occur and how long it has been since the symptoms began.

Heart attack therapy aims to remove the vascular occlusion as quickly as possible. This is the only way to keep the tissue damage caused by the undersupply as small as possible. The therapy recommendations do not differentiate between men and women.

Nowadays, the constriction is usually widened with a tiny balloon during a heart catheter examination (percutaneous transluminal coronary angioplasty, balloon dilatation). A vascular prosthesis made of medical wire in the form of a small tube, a so-called stent, is inserted directly to prevent the vessel from occluding again.

Drugs can help dissolve the blood clot. However, this procedure is used less frequently today.

What happens after a heart attack?

Intensive follow-up care takes place after the acute therapy.

To prevent another heart attack, medication is prescribed that thins the blood and makes the heart work easier. In addition, risk factors are identified. At best, lifestyle advice and the proper medication should eliminate these risk factors.

Follow-up treatment in a rehabilitation clinic, a so-called rehab, is also part of the follow-up care. It should help you find your way back into everyday life. Unfortunately, these rehabilitation treatments are often less accepted by women than men and are also prescribed less frequently. 2.3

Important risk factors in women

Various factors play a role in the development of coronary heart disease and, as a result, a heart attack. For women, the following are particularly important:

• Smoking
• high blood pressure
• Lipid metabolism disorders (e.g. hypercholesterolemia, hypertriglyceridemia)
• overweight and obesity
• Type 2 diabetes mellitus
• Taking the pill (oral contraception)
• psychosocial factors (e.g. depression )

Most women only suffer a heart attack at an advanced age since the high estrogen levels before menopause have a protective effect against coronary heart disease due to their influence on fat metabolism and blood pressure. However, the risk of a heart attack increases, especially in young women, if they are exposed to the risk factors mentioned above.

 

heart attack in young women

In young people, larger tissue areas are often affected by a heart attack, and the consequences are correspondingly more severe.

This is because young people are less likely to have so-called collaterals. Collaterals are arteries that can supply a specific area in a roundabout way. These arise when occlusions slowly form, such as vascular calcification progressing in old age. The tissue then realizes it is getting little oxygen and sends signals that lead to the formation of new blood vessels. If there are no collaterals, a larger area of ​​tissue is affected by vascular occlusion.

The risk of a heart attack is particularly increased in young women if they are also taking the pill and are exposed to other of the risk factors mentioned above. The pill alone increases the risk in young women only slightly.

What is a silent heart attack?

If a heart attack is not accompanied by the pain described above, it is referred to as a silent or silent heart attack. Quite often, silent heart attacks occur in very old patients or people with diabetes. Nerve damage is typical in them, so pain can no longer be felt.

A silent heart attack is sometimes noticed by other symptoms that can accompany a heart attack. Which includes:

• Sudden shortness of breath due to pulmonary oedema (accumulation of fluid in the lungs) from the heart
• low blood pressure, weakness and loss of consciousness
• confusion
• cardiac arrhythmias
• Vascular occlusions in the extremities, i.e. the arms and legs

A medical clarification of the symptoms should be carried out in any case. However, these warning signs are not specific to a heart attack and can also point to other clinical pictures.

How can women prevent a heart attack?

You can prevent a heart attack by avoiding risky behaviour. A healthy diet, regular exercise and not smoking can prevent many of the risk factors mentioned above and counteract other diseases in addition to a heart attack.