Women and heart attacks; Symptoms often go overlooked.

Heart attacks are usually thought of as a predominantly male problem, but women have them just as well.

One key difference: women are more prone to what’s often known as silent heart attacks. There’s no chest-clutching moment of terror or shooting pains down an arm, so the symptoms can be easy to dismiss as nothing serious.

In fact, heart attack signs in women — like jaw or neck pain, indigestion and trouble sleeping — can be misinterpreted as natural postmenopausal discomfort, said cardiothoracic surgeon Dr. John Perry of Novant Health Cardiovascular and Thoracic Surgery at Hilton Head Medical Center.

Men who suffer from heart attacks usually describe an elephant sitting on their chest. But women seldom experience the same sensation, Perry said.

“That’s why they tend to ignore symptoms,” he added. “Awareness is key, because when women present atypical symptoms later in life, around age 60, they’re at a higher risk of complications from heart failure and other cardiovascular issues like stroke.”

Heart disease is the leading cause of death for women in the U.S.. But it can often be managed with a healthy diet and exercise regimen that includes at least 30 minutes a day of strength training and cardio, like brisk walking.

Here, Perry discusses heart attack symptoms that women should never ignore.

Why are there differences in heart attack symptoms between women and men?

For women, it comes down to their smaller size and their hormonal makeup. Women also have a lower red blood cell count, which can predispose them to heart issues.

All the risk factors that predispose people to cardiovascular disease — smoking, family history, cholesterol, diabetes and high blood pressure — afflict men and women equally. But there are other risk factors that can affect women disproportionately. For example, women in their 60s are more likely than men to have high blood pressure (hypertension) but less likely to seek care. That means it’s undertreated.

I have operated on women in their 40s, and those cases scare me. It tells me they have a more aggressive form of heart disease, especially if they smoke or are diabetic. For women who present early, red flags go up in terms of their risk for undergoing intervention, whether that be angioplasty (opening the artery using a stent or balloon) or other procedure to restore proper blood flow.

Which heart attack symptoms should women watch out for?

Warning signs early on include loss of appetite and trouble sleeping. Women tend to have more atypical symptoms: frequent indigestion, fast heart rate, nausea, headache, coughing, fatigue and vision problems. These are often misinterpreted as postmenopausal symptoms.

Initially, cardiovascular disease was thought of as a predominantly male problem, and only over the last 20 years has it been recognized as a serious problem in women, who tend to have a higher rate of heart failure.

When should someone either see a doctor or head straight to the ER?

The main risk factors are if you’re diabetic, smoke, have high blood pressure or high cholesterol, and if you have a family history. If you have three or more of these, it’s time to take them seriously.

Family history could include what we call premature coronary artery disease, which can occur between your early 40s and early 50s.

When patients come to the ER or see a physician, it’s because they know something is wrong. And the key is not to ignore multiple risk factors. Some patients heed that warning and come in, and some ignore it. And they are usually the ones who are at risk for a sudden cardiac event. It’s important to remember that women may present symptoms later, but are at a higher risk for complications from heart failure.

At what point should a woman seek a heart evaluation?

For starters, we all need to see a physician or other provider every year. You should always take symptoms seriously, but especially if you have three or more of these risk factors: a family history of heart illness, diabetes, high blood pressure, high cholesterol and smoking.

Family history is especially critical, because you can’t do anything about it. But diabetes, high blood pressure, high cholesterol and smoking should be treated aggressively, and as early as possible.