This line of thinking is based on the fact that blockages in the major heart arteries are a primary cause of heart attacks in men. A study published in the February 2018 issue of Circulation showed how faulty this reasoning is: Women can have a heart attack in the absence of blocked arteries. In the study, which is part of the ongoing Women’s Ischemic Syndrome Evaluation (WISE) research project, researchers looked at 340 women who had complained of chest pain but were found not to have coronary artery blockages on angiograms. After undergoing cardiac magnetic resonance imaging (MRI), 8 percent of the women were found to have scars on their hearts, which indicates they’d had a heart attack; yet a third of these women had never been diagnosed with a heart attack. The take-home message for women: “Listen to your body, and get a second opinion from an expert if you doubt the diagnosis or management plan,” says Dr. Bairey Merz, the principal investigator of the WISE study. RELATED: How Heart Attack Symptoms Differ in Men And Women
Heeding Heart Attack Warning Signs
Many women don’t get the appropriate tests because they’re perceived to be at low risk for a heart attack — “and they are considered low-risk because their heart disease symptoms are different than the symptoms men experience," Bairey Merz explains. Rather than the crushing chest pain that men often experience, women often experience the following during a heart attack, according to the American Heart Association:
Uncomfortable pressure, squeezing, or fullness in the center of their chestPain or discomfort in one or both arms, the neck, jaw, back or stomachShortness of breath, either with or without chest discomfortBreaking out in a cold sweat, nausea, or light-headedness
Any symptom above the waist, including the chest, arms, neck, jaw, and belly button area, or overwhelming weakness or fatigue, should send you to your doctor or local emergency department pronto, Bairey Merz says. Once you’re there, if you suspect you may have had a heart attack, don’t let a physician dismiss your symptoms as nothing to worry about just because your coronary arteries aren’t blocked, she adds. “If a woman with no obstructive coronary artery disease [CAD] has ischemic symptoms such as chest discomfort or shortness of breath that isn’t going away with rest, she should be evaluated for a heart attack,” says Janet Wei, MD, a cardiologist and assistant professor of medicine at the Barbra Streisand Women’s Heart Center at Cedars-Sinai. The evaluation starts with an ECG and a troponin test, Dr. Wei says. Troponin is a protein that is released into the blood when the heart muscle has been damaged, such as during a heart attack. If you’re told that you haven’t had a heart attack, but episodes of chest discomfort continue, you should be evaluated for coronary vascular dysfunction, Wei adds. This can be done with specialty tests such as a cardiac MRI or cardiac PET scan or coronary reactivity testing (an angiography procedure used to examine blood vessels in the heart and how they respond to different medications), all of which are available at top medical institutions. The bottom line: “Women with symptoms of ischemia [restricted blood flow to the heart] and no obstructive CAD are not as low risk as many physicians may think,” Wei says, “and they should seek further evaluation to determine the cause of their chest discomfort.” Persistence is important for the sake of your heart and general health. RELATED: Will the Right Tests Keep You From Having a Heart Attack?
