Dr. Sarrel describes a heart attack, shares the common symptoms that present in women, and recalls an example of a woman who had a heart attack.
What is a heart attack? That’s a very important question because there’s a lot of confusion about what is a heart attack. Basically it’s a situation in which the blood flow, the arteries bringing oxygen to heart muscle, are not delivering enough oxygen to keep the tissue alive. So there has been a reduction either because the artery is constricting or because the artery is blocked. So there’s not enough blood flow getting through to the muscle tissue and not enough oxygen getting to the tissue and the tissue dies.
So during a heart attack what happens is called an infarct, and an infarct is dead tissue, dead muscle, which will then affect the subsequent function of the heart. That’s a heart attack leading to a change in cardiac function, heart function.
The signs of an impending heart attack, the signs of the event already occurring, first sign typically is feeling very anxious. That’s a classic sign – restlessness, and then a pressure in the chest and the pressure can feel like something squeezing.
In the classic description of a heart attack, mostly drawn from studying men, the pressure goes into the jaw or it goes down the left arm and there is numbness. This is all reflecting an impact on nerve supply and oxygen to the tissue. But in women it can be very subtle. So in fact, there are differences in the symptoms that women have than the classic symptoms described for men.
One of the more common symptoms in women at the beginning of a heart attack is nausea. That leads often to a misdiagnosis because try to imagine the woman who is feeling this special kind of nause, who may go to an emergency room with her problem and because she is a woman it’s not going to be the first thought that she is having an early heart attack, and it’s not unusual for her to be sent home with some kind of antacid or something to treat her stomach upset.
I will give you an example of one of our cases. A 34-year-old woman came to an emergency room in Connecticut complaining of severe nausea. It just so happened it was occurring on the day that her period was beginning – that’s an important clue, the sudden development of a symptom with development with the onset of the period means her hormone, her estrogen, has dropped.
She was extremely anxious and her blood pressure was elevated. So she was given something for anxiety and she was given an antacid and she was sent home. About 12 hours later she came back to the emergency room and then it was obvious her heart was reacting and she was sent to our emergency room at Yale New Haven Hospital. I became aware of the case the next day. By then it was too late to do anything and she died.
Part of the story that was so important, number one, she was a single mom with all the stresses of being a single mom. Secondly, she was a smoker. Third, what had happened was the onset of her period, but the day before, on Sunday, her 14-year-old daughter had been arrested for shoplifting. Here she was faced with this; it was like the perfect storm – everything that could have happened suddenly caved in on her. She had terrible stress. She was compromised because smoking affects the ability of the arteries to stay dilated. We should talk about that some more.
And so, what happened in the autopsy room was, and I was there when it was done, she had perfectly normal appearing arteries. Her arteries had constricted in reaction to the stress, the loss of estrogen being able to keep her arteries open, and of course smoking compromising the function, and we had a dead 34-year-old woman.
About Dr. Sarrel, M.D.:
Philip M. Sarrel, M.D., completed his medical education at New York University School of Medicine, his internship at the Mount Sinai Hospital, and his residency at Yale New Haven Hospital. In addition to his many years on the faculty of the Departments of Obstetrics and Gynecology and Psychiatry at Yale University School of Medicine, Dr. Sarrel has also been a Faculty Scholar in the department of psychiatry at Oxford University, Visiting Senior Lecturer at King’s College Hospital Medical School at the University of London, Visiting Professor in Cardiac Medicine at the National Heart and Lung Institute in London, and Visiting Professor in the Department of Medicine at Columbia University College of Physicians and Surgeons in New York. He is currently Emeritus Professor of obstetrics, gynecology, and psychiatry at Yale University.