Diagnosing coronary heart disease can be more challenging in women than men. For example, chest pain, the classic symptom of heart attack in men, is often not a symptom in women. Indeed, very little is known about the early warning symptoms of heart attack in women. This may lead to the dismissal or misdiagnosis of CHD by physicians who do not recognize the symptoms in their female patients. The fact that women die of sudden cardiac death more than men may be partially attributed to these diagnostic errors.

To address this issue, a group of researchers set out to identify the most common early warning and acute symptoms of heart attack experienced by women. Their study, published in the November 3rd, 2003 issue of Circulation: Journal of the American Heart Association , found that most women experience one or more early warning symptoms prior to having a heart attack, and that these early warning symptoms are indeed different than men’s.

About the Study

The researchers enrolled 515 women who had experienced a heart attack within the last four to six months. Each woman was asked, via telephone survey, to describe both her early warning symptoms and the symptoms she experienced during her heart attack (acute symptoms). Early warning symptoms were rated according to their intensity (ie, mild, severe), frequency (ie, daily, weekly), and time frame (ie, week of the heart attack, within the month prior to the heart attack). Acute symptoms were rated according to their intensity only.

For the purposes of this study, early warning symptoms were defined as:

  • Any symptom that was new or that changed in either frequency or intensity during the month before the heart attack
  • Symptoms that were intermittent before the heart attack
  • Symptoms that disappeared before the heart attack and returned afterwards

Acute symptoms were defined as symptoms that appeared at the time of the heart attack and did not go away until after the heart attack had been treated.

The Findings

The researchers found that as many as 95% of the women in the study reported experiencing one or more early warning symptoms, some for as much as four to six weeks prior to their heart attacks. The most commonly reported early warning symptoms were:

  • Unusual fatigue (70.7%)
  • Sleep disturbance (47.8%)
  • Shortness of breath (42.1%)

The most common symptoms reported during their heart attacks were:

  • Shortness of breath (57.9%)
  • Weakness (54.8%)
  • Unusual fatigue (42.9%)

Only 29.7% of the women in the study reported chest pain as an early warning symptom and 43% did not experience chest pain even during their heart attack.

How Does This Affect You?

The study concluded that most women experience one or more early warning symptoms prior to having a heart attack, but that these early warning symptoms did not typically include chest pain, the “classic” early warning symptom most commonly associated with heart attack in men.

In fact, fewer than 30% of the women in the study reported chest pain and discomfort before their heart attacks and 43% did not even experience it during their heart attacks. This may be one reason why women have more unrecognized and misdiagnosed heart attacks than men.

Instead of chest pain, the women in the study experienced early warning symptoms such as indigestion, sleep disturbances, or weakness in the arms, which many of us experience on a daily basis. These early warning symptoms, therefore, may not be terribly useful since most of the time they do not predict an imminent heart attack. However, recognizing the fact that many women in the throes of a heart attack do not complain of chest pain may be of considerable value. Women at high risk for CHD and their doctors should think twice before disregarding the possibility of heart attack simply because they may not present with classic symptoms.