How Nurses Can Spot the Symptoms of a Heart Attack in Women

• Learn how to recognize the unique symptoms of a heart attack, or myocardial infarction, in women versus men and how this early identification can increase the chances of a positive outcome for patients.
• Understand prevention and treatment methods for heart attacks in women, including lifestyle and diet changes like managing stress, avoiding smoking, staying physically active, etc.
• Once you understand how to identify the symptoms of a heart attack in women you can also provide them with resources to aid in their recovery and connect with a support network.

A 65-year-old woman is clutching her chest with a pained look on her face. Did she hear bad news from her child, does she have indigestion after that delicious burrito, or is she having a heart attack?

Nurses need to be great detectives to accurately assess many symptoms and identify a patient’s problem. The difficult concept about recognizing the symptoms of a heart attack in women is that a heart attack can manifest similar symptoms to many other conditions, and some are different than for men.  An astute nurse needs to be able to recognize the clinical manifestations of a heart attack quickly by asking the right questions in order to move rapidly into the life-saving treatment.

What Are the Symptoms of a Heart Attack in Women?

The humorous and true story is told of an emergency room physician who must break the news to a wife that her husband Henry experienced a fatal myocardial infarction. Despite the heroic efforts of the team, Henry’s heart couldn’t survive the extreme coronary artery ischemia and he died from a massive myocardial infarction.

Dumbfounded and in shock, the wife walked to the family waiting room and announced to the rest of her anxiously waiting family, “Henry died of a massive internal FART!”

While humorous that the technical medical jargon was misinterpreted, we need to remember to use common language that people will understand. Most everyone has heard of the term heart attack, but perhaps not a myocardial infarction.  You may have never heard that term until you went to nursing school.

A heart attack, also known as a myocardial infarction, occurs when there is a sudden blockage of blood flow within the arteries of the heart, which blocks oxygen to the heart muscle, known as ischemia. Without oxygen any muscle, tissues, and cells die. When the cardiac muscle is starved of oxygen it dies, and that affects its ability to work as a pump. The progressive loss of oxygen creates clinical symptoms that nurses can recognize.

The clinical manifestations may vary, but common symptoms of a heart attack in women and in men include the following:

• Chest pain or discomfort: This is the most common symptom of a heart attack. The pain is often described as a feeling of pressure, squeezing, fullness, or pain in the center of the chest. It may last for a few minutes or come and go. Uniquely, women may not sense central chest pain.
• Pain in other areas: Pain or discomfort may also be felt in the arms (especially the left arm), back, neck, jaw, or stomach. Radiating pain to the abdomen is more common in women.
• Shortness of breath: Difficulty breathing or feeling out of breath may occur with or without chest pain.
• Sweating: Cold sweats may occur, even if the individual isn’t engaged in physical activity.
• Nausea and vomiting: Some people experience a feeling of sickness or may vomit during a heart attack. This is common in women.
• Fainting or dizziness: Feeling faint or dizzy may be a symptom, especially in women.

The unique clinical manifestations of a heart attack in women not generally shared by men include fainting, indigestion, and extreme fatigue. Those symptoms can begin suddenly or may be slow to develop such as fatigue and be passed off as something less serious.

What are the Risk Factors of a Heart Attack for Women?

As the symptoms of a heart attack in women and men can differ, it’s important for nurses to recognize those differences. These differences can lead to delayed diagnosis and treatment.

It’s important to note that the symptoms of a heart attack in women can be subtler and may not always fit the classic “crushing chest pain” stereotype, which can lead to delayed recognition and treatment. If anyone, regardless of gender, experiences symptoms suggestive of a heart attack, it is crucial to seek immediate medical attention. Prompt treatment can significantly improve the chances of a positive outcome.

Some of the unique symptoms of a heart attack in women may include:

• Unusual fatigue: Women may feel extremely tired or fatigued, even without physical exertion.
• Indigestion or abdominal discomfort: Women may experience pain or discomfort in the upper abdomen, similar to indigestion.
• Back or jaw pain: Pain in the back or jaw can be a presenting symptom in women.
• Shortness of breath without chest pain: Women are more likely than men to experience shortness of breath without typical chest pain. This is also seen in people with diabetes who may not sense chest pain at all because of neuropathy.
• Pain in the upper back, shoulders, or neck: Women may experience pain in these areas during a heart attack, which is also called radiating pain.

The incidence, or occurrence of new heart attacks in one year in the United States has been on the rise in the past few decades. It is possibly related to the growing (pun intended) rate of obesity and diabetes in our country, which contributes to cardiac disease.

The incidence of heart attacks in women varies with age. Women over the age of 55 are at a higher risk of experiencing a heart attack compared to younger women. The prevalence (total number of cases of heart disease) in American women has been significant.

In 2021 statistics show that 1 out of every 5 deaths among women is due to heart disease.  Currently, it is estimated that 60 million women are living with some form of heart disease, which represents almost 44% of all women.

Many women live with heart disease as an ongoing condition that requires medical management and lifestyle changes. Knowing how to decrease their risk factors and then living the habits of health can help decrease the incidence and prevalence of heart disease in women.

Common risk factors for heart attacks in women include smoking, high blood pressure, high cholesterol, obesity, diabetes, sedentary lifestyle, family history of heart disease, and menopause due to hormonal changes.

Research shows that as estrogen levels decline after menopause, the cardioprotective benefits also decline. Interestingly, despite the aggravation of menstrual cramps and uncontrollably eating pints of ice cream during your period, estrogen helps keep the endothelial lining of coronary arteries smooth, which helps decrease plaque build-up.

It is plaque build-up that blocks arteries and causes ischemia threatening oxygen’s ability to move through the arteries. After menopause, this benefit is lost making women at equal rate of developing cardiac disease as men.

How Can Women Prevent a Heart Attack?

Preventing a heart attack involves making positive lifestyle changes and managing risk factors. Women can take several steps to reduce their risk of heart disease and heart attacks:

• Adopt a heart-healthy diet: Focus on a diet rich in fruits, vegetables, whole grains, lean proteins (such as fish and poultry), and healthy fats (such as olive oil and avocados). Limit the intake of saturated and trans fats, added sugars, and salt. Research shows a Mediterranean diet as listed above helps decrease and even repair heart disease.
• Stay physically active: Engage in regular physical activity, such as brisk walking, jogging, swimming, or cycling. Aim for at least 150 minutes of moderate-intensity exercise or 75 minutes of vigorous-intensity exercise per week, or a combination of both.
• Maintain a healthy weight: Being overweight or obese can increase the risk of heart disease. Aim for a healthy weight through a combination of a balanced diet and regular exercise.
• Avoid smoking and limit alcohol consumption: Smoking is a significant risk factor for heart disease, so quitting smoking is essential. If you drink alcohol, do so in moderation, which is up to one drink per day for women, for a maximum of < 7 drinks/week. No, red wine doesn’t cure heart disease.
• Manage stress: Chronic stress can contribute to heart disease. Find healthy ways to manage stress, such as practicing relaxation techniques, meditation, yoga, or engaging in hobbies.
• Control blood pressure: High blood pressure (hypertension) is a risk factor for heart disease. Regularly monitor blood pressure and follow your healthcare provider’s advice to manage it effectively. Aim for a blood pressure less than 130/80 mg/dL but not lower than 90/60.
• Manage cholesterol levels: High levels of LDL cholesterol (often referred to as “bad” cholesterol) and high triglycerides > 100 can contribute to plaque buildup in the arteries.
• Manage diabetes: For people with diabetes, it’s crucial to control blood sugar levels through diet, exercise, and medications. Interestingly, a medication class known as GLP-1 agonists (name brand Ozempic) have been shown to help with weight loss and blood glucose control without causing hypoglycemia.
• Get regular check-ups: Schedule regular visits with a healthcare provider to monitor heart health and address any concerns or potential risk factors.
• Know your family history: Understanding your family’s history of heart disease can help assess your risk and take appropriate preventive measures.

By adopting a heart-healthy lifestyle and managing risk factors, women can significantly reduce their chances of experiencing a heart attack and promote overall cardiovascular health. It’s essential to work closely with a healthcare provider to create a personalized prevention plan based on individual health needs and risk factors. Health coaches are also wonderfully helpful to teach and create accountability for these habits of health.

What are the Treatments for a Heart Attack?

The treatment for a heart attack has the overall goal to restore blood flow to the blocked artery as quickly as possible to minimize damage to the heart muscle. The main treatments for a heart attack include:

Immediate medical attention is needed!

At the first sign of a heart attack or if you suspect you are having one, call emergency services (911 in the United States or the emergency number in your country) immediately. Time is critical in preserving heart muscle and preventing complications.

Nurses know the pneumonic “MONA” or morphine, oxygen, nitroglycerine, and aspirin (which has changed to ONMA to represent the preferred order).

Oxygen therapy

Supplemental oxygen may be given to improve oxygen levels in the blood to help the starving heart muscle.

Nitroglycerine, Morphine, and other Medications

After a heart attack, you may be prescribed medications to manage heart function, reduce the risk of further clot formation, control blood pressure, lower cholesterol levels, and manage other related conditions like heart failure or arrhythmias. Morphine is given not just for pain relief, but also for its vasodilation effects on the heart vessels.

Thrombolytic therapy (clot-busting drugs): If emergency medical services are not immediately available, or the hospital is far away, certain clot-busting medications may be administered to help dissolve the blood clot causing the heart attack. This therapy is most effective when given within the first few hours of a heart attack but carries a risk of bleeding complications and may not be suitable for all patients.

Aspirin

If you are experiencing a heart attack and emergency medical services have been called, you may be instructed to chew and swallow an aspirin. Aspirin helps to prevent further blood clotting and can improve outcomes during a heart attack.

Additional diagnostic and treatment measures can include the following:

Coronary angioplasty (percutaneous coronary intervention, PCI)

PCI is a minimally invasive procedure performed in a cardiac catheterization lab. During the procedure, a thin tube with a balloon on its tip (catheter) is threaded through a blood vessel to the blocked artery in the heart. The balloon is inflated to open the artery and restore blood flow. In many cases, a stent (a small mesh tube) is placed in the artery to help keep it open.

Coronary artery bypass grafting (CABG)

In some cases, if the blockage is extensive or PCI is not feasible, CABG surgery may be recommended. This involves taking a healthy blood vessel from another part of the body and grafting it onto the blocked coronary artery to bypass the obstruction and restore blood flow to the heart.

Cardiac rehabilitation

Following a heart attack, a cardiac rehabilitation program may be recommended. This program includes supervised exercise, lifestyle counseling, and education to help patients recover, reduce risk factors, and improve heart health.

The specific treatment approach depends on factors such as the severity of the heart attack, the location of the blockage, the patient’s overall health, and the available medical facilities.

What Resources Are Available for Women to Learn More?

Besides identifying the symptoms of a heart attack in women, nurses can help their patients by pointing them to additional services. Often our time with a patient is so brief in the hospital and there is so much more information available for them. Several resources are available to help women prevent or recover from heart attacks. These resources include educational materials, support networks, online platforms, and healthcare services. Here are some valuable resources:

American Heart Association (AHA):

The AHA provides a wealth of information on heart disease prevention, heart-healthy living, and recovery from heart attacks. Their website offers articles, guides, videos, and interactive tools to help women understand their risks and take proactive steps to improve heart health.

WomenHeart:

The National Coalition for Women with Heart Disease: WomenHeart is a nonprofit organization dedicated to providing support and education to women living with or at risk for heart disease. They offer resources, online support groups, and community-based support networks.

Go Red for Women: 

This campaign, also initiated by the AHA, focuses on raising awareness about heart disease in women. Their website offers educational materials, heart-healthy recipes, and information on local events and activities.

National Heart, Lung, and Blood Institute (NHLBI):

Part of the National Institutes of Health (NIH), NHLBI provides resources and research-based information on heart health. They offer guides on heart-healthy living and heart disease prevention, including resources specific to women.

Cardiac Rehabilitation Programs: These programs are designed to help individuals recover from heart attacks and other heart-related conditions. They typically involve supervised exercise, education, and support to improve heart health and reduce risk factors. Ask your healthcare provider about cardiac rehabilitation programs available in your area.

Local Hospitals and Clinics: Many healthcare facilities offer support groups and educational sessions on heart health. These sessions can be beneficial for women who want to learn more about heart disease prevention and recovery.

Telemedicine and Health Apps: There are various telemedicine services and health apps that can provide personalized guidance on heart health, including monitoring risk factors, tracking medications, and lifestyle changes. A popular health app is MyFitnessPal which helps track meals, weight, movement, and more.

Community Events and Workshops: Local community centers, health organizations, and hospitals often host workshops, seminars, and events focused on heart health. Attending these events can provide valuable information and networking opportunities.

Healthcare Providers: Your primary care physician or cardiologist is a valuable resource for personalized advice on heart health, risk assessment, and prevention strategies.

Online Support Forums and Social Media Groups: Joining online communities focused on heart health can provide a supportive environment where women can share experiences, ask questions, and find encouragement.

Remember, the information obtained from online resources should be from reputable sources such as medical organizations and government health agencies. It is always essential to consult with qualified healthcare professionals for personalized advice and treatment plans based on individual health needs.

The Bottom Line

It is crucial to seek immediate medical attention if you suspect a heart attack. The earlier the treatment is initiated, the better the chances of a positive outcome and minimize long-term damage to the heart muscle.

Nurses need to recognize the symptoms of a heart attack in women who may have more silent symptoms beyond chest pain such as indigestion, dizziness, fainting, and nausea. Nurses who are better informed can then be an advocate to teach women to recognize these symptoms in themselves and support their fellow female friends and family.

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