Heart Attack Symptoms in Women – A Must Read

I came across a post in KevinMD with stories from women (many in their 30s and 40s) who suffered from serious heart attacks. I commented on this post in #5. I strongly urge you to read the entire article. I’ve also posted my reply below:

Wow! I was riveted while I read through the entire post. We know that younger women can have heart attacks, and it’s acknowledged that doctors are not good at picking up heart attack symptoms in younger women.

Here are a few observations that I had:

1. Many of the women had heart attacks from 3-5 AM. One study showed that people with obstructive sleep apnea have heart attacks during this timeframe, as compared to earlier in the morning in people who don’t have sleep apnea and have heart attacks.

2. Many women also described severe heartburn as a major symptom. If these women were having a sudden increase in the number and severity of apneas, then it’s expected to have more severe reflux, due to the negative pressures in the chest. One woman, Lidia, had too much to eat and drink for her birthday. Alcohol relaxes your throat muscles, and additional reflux from stomach juices can cause more obstructions and arousals.

3. One woman described recent 10 pounds weight gain—an additional risk for obstructive sleep apnea.

4. Also notice how many women either were pregnant or post-partum. Weight gain during pregnancy is a major risk for obstructive sleep apnea, which can lead to pre-eclampsia and gestational diabetes. That’s also why pregnancy complications are linked to a higher rate of heart disease—because you’re at risk for having obstructive sleep apnea. Post-partum, the protective effect of progesterone is gone (progesterone tenses your upper airway dilators), and more frequent breathing pauses can tip you over the edge.

5. I’m willing to bet that many of these women snored, but it’s also been shown that you can be young, thin and not snore to have significant obstructive sleep apnea. What I’m sure of is that one or both parents of these women snores heavily, with major cardiovascular disease. Typically, these women won’t be able to sleep on their backs, due to smaller oral cavity jaw structures, which narrows the posterior airway space. Deep sleep will relax the muscles, making them more prone to breathing pauses.

6. Some of the women also mentioned casually that they were sleep deprived. Not sleeping enough can be a major trigger to cause major sympathetic stimulation when normally, you’re not ever able to get efficient sleep at all.

7. I bet that most of these women, even when younger, never felt refreshed, no matter how long they slept. Typically, these women will attribute their fatigue to anemia, stress, TMJ, sinus infections, migraines, hypothyroidism, insomnia or chronic fatigue. Many will also have cold hands or feet, and oftentimes, blood pressure will be one the low side, especially when younger (later on, the BP normalizes and then goes high). This is called upper airway resistance syndrome, a variation of obstructive sleep apnea, where you can stop breathing 10 to 20 times per hours and not have official sleep apnea on a sleep study.

It’s important to pick up the atypical symptoms of heart attack in women, but what’s just as important is to treat what’s actually aggravating, if not causing the heart disease. If this had been done months or years prior to their heart attacks, many of these cardiac events could have been prevented.

In these women, there was usually some trigger that tipped them over the edge, whether it’s weight gain, eating late, severe stress, drinking alcohol, pregnancy, or even weather changes. There’s so much proven evidence showing that most people with heart disease have (or will have) significant obstructive sleep apnea. Physicians have to erase the image of the traditional sleep apnea patient as being overweight, snoring, male, with a big neck. Sleep apnea is a craniofacial, anatomic problem due to smaller jaws. Obesity comes later, which only makes the problem worse.


Learning the benefits of the Coronary Artery Bypass Surgery versus traditional surgery may be a good option for women who currently suffer from heart problems.

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8 thoughts on “Heart Attack Symptoms in Women – A Must Read

  1. Thanks, Dr. Park, for mentioning my post on KevinMD.com (originally ran on my blog, HEART SISTERS, at: http://myheartsisters.org/2009/08/14/how-does-it-feel/ I did respond to your comments there – but mine is still “awaiting comment moderation”! Stay tuned….

    The more I reflect on the link between sleep apnea and heart disease, the more anecdotal examples I can recall of women telling me about their severe sleep issues, some only now, post-heart attack, being professionally addressed.

    Because I too had pre-eclampsia during my first pregnancy, I’m particularly interested of course in your observations on pregnancy complications and their links to subsequent (or underlying! – which came first?) heart disease.


  2. I am reading the post and it just really scares me. I have had a normal calcium scoring CT of my coronaries and a normal cardiac workup with stress echo etc, so I wasn’t worried about this for myself, but so many of these women had problems with dissection and spasming and aneurysms, which all sound like they could be complications of sleep breathing disorders, and of course so many had trouble starting in sleep. spasms from hypoxia, and dissections and aneurysms could be from the severe pressure changes in the chest. if UARS can cause the entire heart to collapse, then it could certainly cause these changes in the coronary arteries. and a normal cardiac workup is not necessarily going to mean a thing.

  3. Hi Dr. Deb, I’m the author of the original post “How Does It Really Feel To Have A Heart Attack? Women Survivors Tell Their Stories”. Sadly, there does appear to be a strong gender bias in both diagnosing and treating women heart patients. You’re right – it IS scary!

    Not only is your “normal” cardiac workup absolutely no guarantee that a cardiac event won’t be in your future, but many of the current diagnostics that cardiologists now use routinely were designed, researched and developed for male patients, not females, and may have considerable limitations in accuracy as a result.

    Take the standard treadmill stress test, for example, considered about 80% accurate in identifying cardiovascular disease in men, but as low as 40% accurate for women.

    As the Cleveland Clinic reports: “The truth is that some non-invasive diagnostic tests simply are not as accurate in women as they are in men for detecting early heart disease. Physicians who are aware of this may not refer women for testing simply because they don’t believe the tests will detect a problem. In fact, several studies have shown that women with existing heart disease are more likely than men to have a normal ECG. The problem, according to American Heart Association research, is that an exercise ECG is not very good at detecting heart disease in only one vessel, and that’s the kind that women usually have.”

    This is precisely what happened to me – sent home from the E.R. in mid-heart attack with a misdiagnosis of GERD, despite presenting with crushing chest pain, nausea, sweating and pain radiating down my left arm. All cardiac tests (EKG, cardiac enzymes, and treadmill stress test) were “normal”. I left the E.R. that morning feeling embarrassed and apologetic for having wasted five hours of their valuable time and making a fuss “over nothing”.

    Two weeks of increasingly debilitating symptoms later, I finally returned to the E.R. when symptoms became truly unbearable, this time to a revised diagnosis (“significant heart disease”) and a trip directly from the E.R. to the O.R.

    Women can typically experience both single-vessel disease and non-obstructive disease (like Prinzmetal’s angina) far more frequently than men do, and both are difficult to catch using our existing diagnostic tools. SCAD of course generally strikes young, healthy women with few if any cardiac risk factors.

    If a cardiac event or anything that even smells like a cardiac event hits (as you saw in this post, the symptoms are all over the map!) women should seek immediate help and keep demanding help until you get it. We know that women – even in mid-heart attack – exhibit ‘treatment-seeking delay behaviors’ that can prove deadly. More on gender differences in diagnosing and misdiagnosing at HEART SISTERS – feed://myheartsisters.org/category/diagnosing-and-misdiagnosing/feed/

  4. thank you Carolyn. when I finished the post I was overall also struck by how awfully these women were treated in the ER, told they were just having anxiety when it was clearly not that. anxiety is a diagnosis of exclusion and everyone deserves a complete workup. just more of the poor medicine I have seen practiced my entire career. I knew a woman 5 years ago who was 32 yrs old, 32 weeks pregnant, obese with diabetes, who started having chest pains. her doc told her to drink milk, apparently thinking reflux. as a result she felt like she was blowing things out of proportion, so on the way to the ER when she started to feel a little better she decided to just go back home. she died at home, as did her baby. I remember being socialized in medical school to think that women who were emotional were just crazy, nothing wrong with them. it’s a crime.

    as I sit here having intermittent PVCs I’m wondering if I should just go have a tracheostomy. but with no apnea on my sleep study, no one is going to do it.
    Dr. Park, I am grateful to you for increasing awareness of sleep breathing disorders. your work is so important. maybe you should tour medical schools to lecture, to really get the word out to the new generation of docs.

  5. I’m terrified, not so much by my symptoms but at the prospect of facing another diagnosis that goes nowhere. I’m 27 weeks pregnant with my fifth pregnancy. I’m 162 lbs and 5’1″, and was around 128 lbs before each pregnancy. I’ve always gained around 60 lbs during each pregnancy despite what I eat, but the cold hands, cold feet, low blood pressure thing and never having felt refreshed even after 13 hours of sleep is spot on. I’m only 28 years old, and last night I couldn’t breathe but intermittently. My chest and my left rib cage were so tight and painful, I thought labour pains were preferable. I couldn’t speak, couldn’t scream, couldn’t walk, I had to lie down. I basically inched my way to the bed, motioned frantically for my husband to take the kids, and fell asleep while my crying three-year-old stroked my back, awaiting me to nurse her. Her stroking must have calmed me down, because a half an hour later I felt the pain ease and I fell asleep.

    I told my doctor today, and have told him in the past of these symptoms, and he just chocks it up to acid reflux disease or gall bladder disease or “bad coughing spells”. He said to just get Robitussin and I should be fine, and laughed that no one knows what chest pains mean in the medical profession. But what I felt last night, and once or twice in the past during my pregnancy, really scares me. One emergency room doc suggested I get a CT scan for a pulmonary blood clot, but I declined it because he said the risk to the fetus is high.

    I attend the Camp Pendleton Marine Base Navy Hospital for care, which is notorious for having inept – even negligent staff. What should I do? I feel stupid suggesting that or asking if it may be a heart attack I experienced, especially given my age. I did suffer severe pre-eclampsia but only during the first delivery years ago. There’s no history of heart disease in my family, but today my blood pressure – normally 90/60 – was 148/ 93, even when they retested it and I felt “calm”.

  6. Vania,

    Thanks for sharing your story. Everything you’ve told us points to possible obstructive sleep apnea. You should talk to your doctor about ordering a sleep study. Sleep apnea promotes weight gain, pre-eclampsia, reflux, heart disease, and hypertension. Please read the two articles on obstructive sleep apnea and upper airway resistance syndrome under sleep apnea basics.

  7. I’m really worried about my daughter. She is on her second pregnancy and is 25 years old. She is so weak she cannot open a pudding cup. Dizzy. Has no energy. Cannot lift her 16 month old most of the time. She has complained that her collar bone is “tight”. She has trouble getting a good breath. She is 4 months pregnant. I have been helping her for the last 2 or 3 weeks. She says her head feels heavy. She has been tested and is not anemic. Baby’s heartbeat is fine. She doesn’t have high blood pressure. She is short, about 5 ft. Weighs in the 145 range. She carries her babies high and is big chested….she’s wearing an E size cup right now. We always felt like she had trouble getting a good breath because she is short waisted, has large boobs that practically rest on her high tummy. But we do have a history of some heart problems. My paternal grandmother died of a heartattack at 50. My dad had his first heart attack at 51 or 52. Dr. said she has a really bad case of pregnancy weakness. But I’ve never heard of anything like this. Any suggestions?

  8. Wow! This blog hit home. I had my massive heart attack 2wks post partum. I’ve always been small but had a lot of those symptoms described in this blog. I’m going to continue reading as much as possible on this topic. I am currently in congestive heart failure & am an above the knee amputee. I still have the fatigue, migraines, ect Thank you for posting