Heart to Heart

Symptoms of a heart attack are not the same for men and women. Knowing the difference can save your life-or someone you love.

By Jennifer Barrett

Breaking the Mold
Misperceptions run deep when it comes to our hearts. In a recent poll taken by the American Heart Association (AHA), only 8 percent of women named cardiovascular disease as their biggest health concern. But approximately one-half will die from it, as opposed to other threats like breast cancer, which claims one in 27. And confusion does not stop with the patients. Many doctors, too, have remained in the dark about how this disease threatens 50 percent of the population.

Cardiologist Nieca Goldberg, M.D., chief of cardiac rehabilitation and chief of the Women's Heart Program at Lenox Hill Hospital in New York, offers a poignant example. Speaking in front of a group of medical students in the early 1990s, she listened with surprise to the response her co-speaker, a senior cardiologist, gave to a question from the audience. Asked whether women were harder to treat than men, he replied, yes. "They hem and haw," he complained, "and just don't come out and tell you when they have chest pain."

"Well guess what?" Goldberg says, still annoyed years later. "Women don't tend to get chest pain. Women's symptoms of heart attack may be much different than men's. But until only five years ago, all the research had looked at men; women's symptoms have long been viewed as 'atypical.' "

In fact, heart problems in women are different from those in men, beginning with the warning signs. While chest pain, tightness, and pressure mark the classic signs of heart attack in men, women need to watch for other signals—back pain, nausea or dizziness, lower chest and/or upper abdominal discomfort, unusual fatigue, or shortness of breath. You can often distinguish these symptoms from common everyday aches and pains by the circumstance. "When they relate to the heart, warning signs often start when you exert yourself—and after a while, the pain can sometimes get so bad that it comes at rest or in sleep," Goldberg says. "The key is to get checked out when you first suspect something's wrong."

The difference between the sexes even extends to actual traumas like cardiac arrest. "The model we have for a heart attack—the tube gets clogged over time, blood can't get through, heart attack ensues—just isn't the norm in women," says Mehmet Oz, M.D., a New York cardiac surgeon and director of the Columbia Presbyterian Medical Center's Heart Institute. "Ninety percent of arteries in men who have heart attacks have calcium buildup, or plaque. For women, it's only 30 percent." So what's behind the heart failure? "In women, the tube will often have a spasm and shrink to become a little cappellini rather than a big linguini," Oz says. "The spasm interrupts the flow of blood into the heart, which damages the muscle."

Hormones also play a larger role in women. Estrogen provides some immunity against heart disease, and women in childbearing years have ample amounts. The hormone helps keep arteries supple and even widens blood vessels. But as estrogen levels decrease with the onset of menopause, arteries begin to harden, and blood pressure rises. That's why you see a sharp jump in the rate of heart attack cases in the postmenopausal years of 55 to 65. (Until recently, hormone replacement therapy was hailed as a good solution to the menopausal estrogen drop. Unfortunately, it has since been shown ineffective in preventing heart disease.)

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