Women and Heart Attacks

Do Women Feel Chest Pain and Does It Even Matter?

Female with lower back pain, midsection, rear view
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It's long been the belief that women and men have distinctly different symptoms when they have heart attacks. Men have crushing chest pain that runs down the left arm—classic symptoms right out of the textbook. Women, the theory goes, do not.

The problem has always been that nobody can tell us exactly how women are likely to experience a heart attack. Ask a dozen cardiologists to get a dozen different answers. One consistent symptom—or lack thereof—is that women supposedly don't have chest pain.

Childbirth vs. Heart Attack

After childbirth, goes the thinking, a heart attack is nothing.

I've never entirely believed that. One thing is definitely true: Women are tougher than men. I don't have any proof, but what guy do you know who would be able to handle childbirth? I didn't think so. Plus, in almost three decades of treating both men and women, my own experience is that men are wimps compared to women.

I think women feel chest discomfort with heart attacks; they just don't perceive it as pain in the same way men do. A paper in the December 10, 2007 issue of the Archives of Internal Medicine reviewed data from 69 other cardiac studies. The authors found that 25% to 33% of all patients—men and women—who go to the emergency department with acute coronary syndrome (a group of heart attack type problems) don't report feeling pain or discomfort.

Fewer women than men reported feeling chest pain in these studies. The million-dollar word here is reported. Does that mean women didn't feel chest pain? Not necessarily. It means the women didn't say anything, and that might have more to do with being a woman than with the presence or absence of pain.

It's certainly plausible that some of the patients in those studies—of both sexes—who didn't report feeling chest discomfort instead felt pain in the back, or pressure in their arms, or trouble breathing for no reason. These are all different ways the brain can interpret the discomfort signals sent out by the heart.

Chest Pain or No Chest Pain—So What?

Women can feel pain and they can have all the same symptoms of a heart attack as men. One thing to remember as you're surfing the internet trying to tell if that weird feeling you're having in your chest, arm or neck is anything to worry about: If you're worried enough about it to look here for information, then it's time to go to the hospital.

Both sexes can have heart attacks without having chest pain. Both sexes can have heart attacks with symptoms that look just like the heart attacks you read about in those monthly features in your local newspaper. If you're having some sort of new discomfort in your torso or upper arms, whether it is in the middle of your back or the middle of your chest, don't wait until your heart stops to prove it was a heart attack.

Maybe someday somebody will study exactly what the differences are between men and women when it comes to heart attacks. Of course, they may also want to study differences between diabetics and non-diabetics, different cultures, middle age and old age—you get the picture. We'll never know how everyone is going to perceive a heart attack, so it's up to you.

Remember: When in doubt, call 'em out!

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  • Canto, J.G., et al."Symptom presentation of women with acute coronary syndromes." Archives of internal medicine. 10 Dec 2007.