Heart attacks - where women miss out

While women's risk of heart attack is, overall, lower than men's, they are by no means completely immune.

While women's risk of heart attack is, overall, lower than men's, they are by no means completely immune. We all know central crushing chest pain, like a tight band around the chest, can mean a heart attack. However, more than two in five women having a heart attack may not get this symptom. Many people don't realise it's possible to have a heart attack without this pain, so women might delay seeking help.

What women need to know - other possible symptoms of heart attack

Women seem to get a vague discomfort over the lower chest, or possibly in the upper tummy (which can be mistaken for indigestion) more often than men. They often also get these possible symptoms:

  • Feeling sweat
  • Feeling lightheaded
  • Shortness of breath
  • Feeling suddenly very weak or tired
  • Feeling sick and/or dizzy

Heart attack or angina - what's the difference?

A heart attack is a complete blockage of one of the blood vessels which supply blood to the heart muscle. In angina, blood supply is seriously reduced but not completely blocked. Symptoms are similar to those of heart attack but they may be less severe and they tend to settle on their own. However, if you've never had angina before, it is important to seek medical help urgently - angina is an early warning sign that you're at higher risk of heart attack. Getting help early can stop your condition progressing to the 'real thing'.

Why the rush? Why heart attack is an emergency

As we've heard, when you have a heart attack the blood supply to part of your heart muscle is blocked. No blood means no oxygen, and if this lasts long enough, heart muscle is damaged beyond repair. Fortunately, huge advances have been made in recent years in the early treatment of heart attack, which have improved survival rates dramatically. In the short term, treatments include 'clotbuster' medicines to break down the blood clot blocking the artery, and surgery (often carried out using probes guided into the heart arteries through the skin under X-ray control, with no need to cut the chest open at all) to open the artery and put in a tiny metal 'stent' to prevent it from blocking again.

Long-term health

In the longer term, lifestyle steps to look after your heart will hugely cut your chance of another heart attack. However, if you've had a heart attack or angina, you are at higher risk in the future, so your doctors will recommend other medicines to protect you as well. These include statins to lower cholesterol, blood pressure tablets and medicine to reduce the chance of your arteries blocking again in future.

HRT and heart attack - what should I believe?

We all know that younger women have a lower risk of heart attack than men, and it's long been assumed that female hormones - oestrogen in particular - played a part in protecting them. It was always thought that replacing oestrogen with HRT after the menopause would cut that risk. But a few years ago, a big study suggested women given HRT had more heart attacks than those who didn't take it.

So what's the truth? Well, the world has turned full circle, as it so often does in medicine. The women in the study were mostly in their 60s, and many had gone through the menopause many years earlier. They were also already at very high risk of heart attack because of high blood pressure, raised cholesterol etc. Among women in their 50s (the age doctors usually start giving HRT), women taking HRT weren't put at higher risk of heart attack by taking it. However, while that's one worry off your mind, taking HRT long term is still thought to increase your risk of breast cancer, so do talk to your GP about your own case.

Dr Sarah is unable to provide medical advice or respond directly to questions concerning your health. If you have health concerns we recommend contacting your GP.