Women: Do you know the heart attack warning signs?

Every year, thousands of women don shades of crimson to commemorate National Wear Red Day. The event is part of the American Heart Association’s movement to raise awareness about heart disease, which causes 1 in 4 female deaths every year.

Despite the fact that heart disease is the number one cause of death in women, many think of heart attacks as something that happens to older men. And although outspoken advocates like Rosie O’Donnell have shared personal stories of prevention and survival (O’Donnell suffered a heart attack at the age of 50), many women are still in the dark about their risk for heart disease. In fact, young women in particular may be ignoring the early signs of heart attacks and not receiving potentially life-saving treatment.

Each year, 15,000 women under age 55 die from heart disease, making it the leading cause of death for women overall. Younger women are twice as likely to die after being hospitalized for a heart attack as men in the same age group. So why aren’t women rushing to the emergency room at the first sign of trouble? It turns out, the first signs often don’t resemble what many of us associate with heart attacks at all.

Veena Korah, MD

“In addition to the typical chest pain and pressure that goes with a heart attack, women notice a lot of atypical symptoms,” says Veena Korah, a One Medical doctor in Chicago. These can include everything from shortness of breath and indigestion to nausea and a general sense of dread. “They usually attribute these symptoms to other causes like arthritis, heartburn, or anxiety, and they just don’t seek care.”

It’s not only important for women to know the unusual sign so they can get to a doctor fast, but so they can advocate for themselves once they’re there. “Doctors typically underestimate these symptoms in women too,” Korah says. “They tend to send men with the same symptoms for evaluation, but for women we tend to just wait and watch.” To make sure you’re getting the right treatment, remember that any of these vague symptoms can signify heart trouble:

• Nausea, cold sweat, lightheadedness
• Pain or discomfort in one or both arms, the back, neck, jaw, stomach
• Shortness of breath
• Chest pain or discomfort is still the most common symptom, but women are more likely to experience some of the symptoms above

“For some women, the signs of a heart attack may be mild and less specific,” adds Saya Akkad, a One Medical doctor in San Francisco. “But even though women may endure less severe signs of a heart attack, the consequences remain significant. Even mild heart attacks can cause tissue damage that can then lead to additional health problems down the road.”

Aside from misinformation around signs and symptoms, Korah says gender roles also influence the ways women get care — or don’t. “Women tend to deal with symptoms longer because we’re usually caregivers and are worried more about other people before ourselves,” she says. “So they wait to see the doctor until later when heart disease has gotten worse.”

A recent Yale University study examined 30 women between the ages of 30 and 55 who had been hospitalized with acute myocardial infarction (AMI), commonly known as a heart attack. The participants’ heart attack symptoms varied widely in nature and duration, and many of the women thought their symptoms were caused by something other than a cardiac problem. Many said they were concerned about causing a false alarm in case their symptoms weren’t due to a heart attack. And many of the women hesitated to seek emergency medical care because of conflicting priorities and external factors like work or family obligations.

Although many of the patients did not routinely access primary care, including preventive care for heart disease, they weren’t solely responsible for delayed treatment. Many did not receive prompt or complete workups or formal diagnoses, and several women reported that their providers assumed the symptoms were due to acid reflux or gas.

Practicing proper self-care is an important part of prevention. In addition to being educated about the unique signs and symptoms of heart attacks in women, regular check-ups and routine tests are crucial. Be open and honest with your provider and make sure he or she knows if you have high blood pressure, high cholesterol, diabetes, or a family history of heart disease, all of which can influence your risk. “I encourage all women to speak to their primary care doctor about their risk factors for heart disease and what steps they can take to lower that risk,” Akkad says.

Lifestyle changes can make a big impact too. If you’re a smoker, stop now—research shows that coronary heart disease risk is cut by about 50 percent just one year after quitting. Pick up an exercise habit if you haven’t already; just 30 minutes of a walking a day can lower your risk for heart attack and stroke. And if your diet could use some cleaning up, work with a nutritionist to create a heart-healthy, sustainable food plan.