Recognize the Signs The most common heart attack symptom is chest pain, but women are more likely to have other signs, too. They include shortness of breath, weakness, fatigue, cold sweats, pain radiating down the arms, dizziness, nausea or vomiting, and upper back or jaw pain, says Nieca Goldberg, M.D., medical director of the Joan Tisch Center for Women's Health at NYU Langone Medical Center. Think back to how you've been feeling over the past few weeks: Many women have signs including unusual fatigue, sleep disturbances, shortness of breath, indigestion, and anxiety up to a month before a heart attack. Research shows symptoms can vary by age -- for instance, one in five women age 55 or under do not have chest pain during a heart attack. Also keep risk factors in mind: A heart attack is more likely if you're overweight; you smoke; or you have diabetes, high blood pressure, high cholesterol, or a family history of heart disease.
Call 911 Right Away Don't drive yourself to the ER. You could go into cardiac arrest and pass out behind the wheel, says Sharonne N. Hayes, M.D., director of the Women's Heart Clinic at the Mayo Clinic in Rochester, Minnesota. "Ambulances have defibrillators and lifesaving drugs, so you can often start getting treatment before you arrive at the ER," she says. While you're waiting, chew a regular (325 mg) aspirin. It won't stop a heart attack, but it will help keep blood from clotting and might limit damage, Goldberg says. Also, EMTs can administer nitroglycerin tablets to help open arteries and allow more blood to flow to the heart. And they know the best place to take you. "The closest hospital may be five minutes away, but the one that can open your arteries may be 15 minutes away," Hayes says. The EMTs will radio ahead so ER staff are standing by for a potential cardiac emergency.
What to Say in the Ambulance
Be clear about what you're experiencing, and don't hesitate to say firmly, "I think I'm having a heart attack." Studies show that it's harder for EMTs to recognize heart attack signs in women.
When EMTs get to you, stay as calm as possible, and describe what you're feeling. Tell them your medical history, and tell them if anyone in your family has had a heart attack or heart disease; certain risk factors such as a family history might prompt them to take your symptoms more seriously. Share any medications you are taking so the medics know more about your overall condition and can avoid drug interactions.
The EMTs should take your blood pressure and listen to your heart, and monitor your heart rhythm with an EKG machine to detect waveforms that suggest a heart attack. If that doesn't happen, "it's reasonable to say, 'Could this be my heart? Should we do an EKG?' " says Deborah Kwon, M.D., a cardiologist at the Cleveland Clinic.
What to Say at the ER
Be specific and precise about your symptoms. If you do have chest pain, report and emphasize that first, then describe symptoms in a concise, affirmative way. "Women tend to report their emotional experience rather than physical symptoms," says Roxanne Pelletier, Ph.D., a women's heart researcher at the McGill University Health Centre in Montreal. But it helps doctors understand what's happening faster when they hear concise facts like "I've had terrible chest pain, nausea, and shortness of breath for the past hour."
If an EKG shows a heart attack, you might be sent for an angiogram ASAP to open a blocked artery. If the EKG is normal, ask doctors to test your blood for enzymes that indicate heart damage. "The classic screenings look to confirm evidence of a blocked artery, but in women, heart disease that can lead to a heart attack may take other forms," explains Jennifer Mieres, M.D., professor of cardiology at the North Shore LIJ Health System in Lake Success, NY. While your blood is checked, you may be watched overnight and/or get more tests.
Leaving the Hospital
If doctors say you didn't have a heart attack, follow up with your physician in the next day or two. Request a referral to a cardiologist -- ideally one who focuses on women. "You want doctors to get to the bottom of what's going on, and evaluate your risk," Mieres explains. "Women can have more diffuse coronary artery disease that requires extra tests to detect," Kwon says. If you have had a heart attack and/ or a procedure, adhere to the follow-up instructions and prescriptions, and get a referral for cardiac rehabilitation to reduce the chances of a second heart attack.
Most important: There's absolutely no shame if doctors decide you didn't have a heart attack. "Count yourself lucky," Hayes says. "I tell patients, 'Aren't you glad you're here? If this should happen again, come back.' "