Heart disease is the number 1 killer of both men and women in the U.S. and other developed countries. It develops gradually over years and then presents with acute life-threatening problems or subtly with mild symptoms. Understanding the signs and symptoms of heart disease is an important first step in preventing death and significant morbidity from this prevalent disease.

The most common symptom in both men and women is chest pain. It is typically described as a pressure, heaviness or tightness and is sometimes confused with the pain of indigestion. The pain can radiate down the left arm, up the neck and to the jaw or to the back. It can also be associated with fatigue, shortness of breath, sweating and nausea. These are the early symptoms of ischemia and if left un-treated can lead to a myocardial infarction (MI) also known as a heart attack.

Identifying those suffering from acute coronary syndrome (term used to describe heart ischemia related to blockage of the coronary arteries) would be easy if the above symptoms were present all the time but this is not the case. One study showed that of women with a known acute MI, 43% did not report chest pain. Of the group, 58% reported shortness of breath, 55% had weakness and 43% experienced fatigue. In these women, only 30% reported early prodromal symptoms indicating ischemia while the majority had a heart attack on first presentation for care. It is important to note that the early symptoms, which presented more than 1 month before the heart attack included unusual fatigue, sleep disturbance and shortness of breath.

In addition, those presenting with the above symptoms can also be experiencing other problems. The list of other possible diagnosis includes gastroesophageal reflux, stomach ulcer, musculosketal pain, and dissection of an aortic aneurysm. Other cardiac related problems which are not due to ischemia includes Cardiac Syndrome X, which is a problem with the microvascular of the heart and not the traditional coronary artery obstruction; Stress Induced Cardiomyopathy, which is caused by intense psychiatric stress; and a spontanceous Cornary artery dissection which is a rare cause of a MI unrelated to coronary artery disease but due to a sudden tear in the artery.

Women tend to have a worse prognosis than men when they develop ischemic heart disease and in many cases the first presentation maybe a heart attack, heart failure and even sudden death. This is due to a number of reasons. The prodromal symptoms are not necessarily classic for ischemic heart disease and is therefore ignored by the patient and easily misdiagnosed by the healthcare provider. When women seek emergency care for symptoms they are less likely to have an ECG, cardiac monitoring, cardiac blood tests and less likely to be seen by a Cardiologist for further evaluation. They are most likely to be treated for other non-cardiac related complaints.

Risk factors for heart disease are clear. If you have a personal history of heart disease, a family history of heart disease, smoke, have diabetes, have elevated blood lipids and are overweight you should be on guard for any of the above symptoms. Even if you don’t have any of the above, symptoms of chest pain, shortness of breath, and extreme fatigue should drive you to seek care. If you don’t think you are getting an appropriate answer about the cause of your pain be persistent by either following up with the same doctor or seeking a second opinion. Heart disease is a common killer but early treatment can be life saving.

I hope this article has provided you with information that will help you make wise choices, so you may:

Live healthy, live well and live long!