Sue Palmer woke up vomiting and did what most of us would do: She tried to shake it off and go back to bed. But she was experiencing one of the symptoms of heart attacks that women often ignore. And, in an essay Palmer wrote for The Washington Post, the Nashville-based attorney details how her husband Tim insisted that she go to the ER…and saved her life in the process.
According to the CDC, heart disease is the leading killer of women in the U.S. It's responsible for one out of every four female deaths in 2013 (the most recent year for which data is available). Even scarier: Almost two-thirds of women who die suddenly of coronary heart disease report no previous symptoms.
“He whispered, ‘Let’s go to the emergency room,’” Palmer recalled. “‘Why?’ I asked. He replied, ‘You could be having a heart attack.’”
Palmer recounts how she joked about the situation to ER workers, since she felt fine, and even rolled her eyes at the notion that she might be having a heart attack at one point. While one electrocardiogram (EKG) didn’t show that anything was off, a second found that something was very wrong.
She was rushed to an operating room and then was put under. When she awoke, she learned that she had had a major heart attack and was in the process of having it when she arrived at the hospital. Her right coronary artery was 100 percent blocked and the center artery was 70 percent blocked (a problem she says doctors refer to as “the widowmaker” because it’s the most frequent source of sudden death), but doctors had been able to stop the heart attack in its tracks.
“If I had gone back to sleep that morning, as I had wanted to, I may not have awakened, and if I did, there probably would have been devastating damage to my heart,” Palmer wrote. “As it was, I had no damage.”
“The symptoms in women are much less dramatic [than in men],” George S. Abela, M.D., chief of the division of cardiology at Michigan State University tells SELF. “That’s part of the issue that leads many women to ignore their symptoms or not recognize that this may be a heart attack.”
Nicole Weinberg, M.D., a cardiologist at Providence Saint John's Health Center in Santa Monica, Calif., tells SELF that she's seen a female patient whose heart attack presented itself as back pain that came on suddenly and escalated throughout the day. Another had several teeth removed after suffering jaw pain, only to realize that the pain was due to a heart attack that she eventually experienced.
“There’s no real good anatomic basis for it, but it happens all the time,” Dr. Weinberg says. According to Nieca Goldberg, M.D., medical director of the Women's Heart Program at NYU Langone Medical Center, part of the problem may be that men and women describe their pain differently and have different pain thresholds. Women are also more likely to delay getting to the hospital and to worry about feeling silly if they aren't actually having a heart attack, she tells SELF, which may make their condition more serious when they actually do arrive at the E.R.
If you notice something is off but not necessarily an emergency, check in with your doctor. "But if you're at home and these symptoms wake you up or [you get them] when you're sitting down, you need to call 911," she says. Additionally, she says that those who have diabetes may have dampened pain perception and, therefore, may not notice chest discomfort when it arises so it's crucial to be aware of the other heart attack symptoms that may accompany that discomfort.
Below are the symptoms to watch out for, according to our experts and the Mayo Clinic.
The most common symptom among men and women is chest discomfort, Sharonne Hayes, M.D., a cardiologist and founder of the Mayo Clinic’s Women’s Heart Clinic, tells SELF. But that discomfort isn't always the stabbing pain we usually see depicted in movies. In women especially, it may be more likely to manifest as a sense of pressure or tightness Dr. Hayes explains.
That chest pain may not always be felt in the center of the chest either—it can be on the left or right sides, or even in the upper abdomen or back, Dr. Goldberg says. "When it's lower in the chest many mistake for a stomach ailment," Dr. Goldberg says. It can also radiate to your shoulders, jaw, neck, or your left or right arm. "We want [patients] to remember that anything above the waist could be the heart," she says.
Although not everyone gets the classic symptoms, Dr. Goldberg says many have mild heart attack symptoms and warning signs up to six weeks before the actual attack that may go unnoticed. For instance, you might notice that you're getting winded earlier in your workouts than usual without an obvious explanation. At that point, check in with your doctor to figure out what's going on.
They'll evaluate your other heart disease risk factors, including taking your blood pressure, and drawing blood for a cholesterol and glucose test, Dr. Goldberg explains. They'll also probably give you an EKG to look for changes in your heart's activity. If there aren't any obviously concerning test results but you or they are still concerned, your doctor might also give you a stress test in which you'll walk on a treadmill and get your blood pressure taken every few minutes.
Your stress test might be what's called a "nuclear test," meaning you'll be given radioactive drugs that allow your doctor to see the way your heart works as it's working. If your stress test comes back positive, meaning you have an obstructed artery, Dr. Goldberg says you'll need a coronary angiogram, an imaging test to see the blood vessels of the heart.
But, of course, if you're suddenly having trouble breathing, call 911.
Feeling like you're going to faint out of nowhere or actually fainting are both warning signs of a heart attack or other underlying cardiac issue, Dr. Goldberg says. This is especially worrying if it happens while you're working out, which may be a symptom of a rare but serious heart condition, such as Brugada syndrome.
Unusual sweating that comes on suddenly is another surprising—and easily missed—symptom, Dr. Weinberg says. But it can be easily confused with night sweats or hot flashes, which become more common with age. But those events tend to be pretty short (they're usually over within a minute or two). So if your sweating is particularly extreme, doesn't go away, or makes it difficult for you to get back to sleep, it may be a sign of a heart attack.
Nausea and vomiting (as Palmer experienced) are common symptoms for women, Dr. Weinberg says. So it's not totally surprising that people often confuse their heart attack symptoms with food poisoning or other gastrointestinal issues—especially when these symptoms are combined with the possibility of feeling discomfort in the upper abdomen.
Similar to the shortness of breath, Dr. Goldberg says that a new, unexplained, profound sense of fatigue may be a warning sign of a heart attack. Fatigue may also be a symptom of many, many other issues—including anemia, depression, thyroid conditions, and even cancer—so it's important to get checked out by your doctor.
Research suggests that women (especially young women) either don't recognize or tend to brush off the symptoms of a heart attack, at least partly due to anxiety over the possibility of being a "false alarm." So, yes, taking that extra step to get immediate medical attention might seem scary, but it could very literally be the difference between life and death. Basically, it's not a decision you want to leave to your insecurities.
"Nobody's really judging you," Dr. Goldberg says. "It's good news when everything's okay."
Once you make it to the E.R., Dr. Hayes says it’s perfectly acceptable to tell them that you think you might be having a heart attack—especially if you feel like you’re not being taken seriously. “It may make doctors think about something they haven’t thought of,” she says. “At the very least, the standard of care would be an electrocardiogram,” which would help your doctors figure out what's really going on.
If you are indeed in the middle of a heart attack, Dr. Goldberg says you'll be rushed for a coronary angiogram and possibly a procedure in which the artery is opened up in order to prevent heart muscle damage. Other options may be medication to lower blood pressure or bust apart blood clots, or surgery.
Unfortunately, Dr. Weinberg says that even otherwise healthy people can get heart attacks, which means everyone needs to be aware of the possible symptoms—and to get checked out ASAP if there's a concern.
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