Heart Attack Symptoms: Men vs Women

Say the word heart attack and most people think they know what you’re talking about. Crushing chest pain that sends you to the nearest emergency department, right? And while Americans generally do recognize that high cholesterol, high blood pressure, and obesity can increase the risk for having a heart attack, many don’t know that the risk factors and symptoms can differ between men and women or that there are actually different kinds of “heart attacks”. Heart disease is the leading cause of death in the United States and yet the general public has a very limited understanding of the biology behind it. Get to know the ins and outs of how heart attacks work so you can protect yourself and your loved ones.

Table of Contents

Terminology: What exactly is a heart attack? 

Pathology: What is going on during a heart attack?

Treatment: How do doctors treat heart attacks?

Signs and symptoms: Are they having a heart attack? (Men vs. Women)

Risk Factors: Who is at high risk for a heart attack? 

Prevention: Steps you can take to protect your heart health

Terminology: What exactly is a “heart attack”? 

Before I jump into risk factors and pathophysiology, let’s get our terminology straight. When most people use the phrase “heart attack” what they are usually referring to is the medical term, acute coronary syndrome (ACS). ACS is a family of heart diseases that all involve blockage of the arteries that supply blood to the heart itself. While we all know the heart pumps blood out to the rest of the body, it also needs to pump blood to itself. The blood-vessels on the heart that supply it with the necessary oxygen to function are called coronary arteries. There are varying degrees to which these vessels can be blocked in different ways. 

The most common type of ACS that leads to the classic crushing chest pain associated with heart attacks is what is known as a myocardial infarction. This occurs when a coronary artery that supplies oxygen to the heart is completely blocked off. As you can imagine, blood will not be able to flow through this occluded vessel, and the heart muscle will stop receiving oxygen. When an organ does not receive any oxygen from blood flow it is called ischemia. This is the most severe type of heart attack. 

A step down from myocardial infarction is unstable angina. Unstable angina is defined as a chest pain that occurs while physically exerting yourself as well as at rest. The pain is usually continuous and doesn’t get better by taking a moment to rest. The difference between unstable angina and myocardial infarction is that the former involves a vessel that is closer to 70% blocked, instead of 100%.

Before unstable angina, one might experience stable angina. When chest pain occurs during physical activity but resolves after rest, it’s called stable angina. This happens because the coronary artery is only partially occluded. When we exercise, the heart needs more oxygen to beat faster and pump blood out to the body. Because some blood can get by the building blockade, the heart can get enough oxygen at rest, but cannot get enough for higher activity states, causing chest pain only during exercise. 

Pathology: What exactly is going on during a heart attack?

When my dad had his first heart attack in his early 40s, I was only a young child. I didn’t understand what had happened or why Daddy was in the hospital. All anyone could explain to me was that something bad had happened to his heart, and it may have to do with the Wendy’s cheeseburger he ate for lunch everyday. More recently, my dad was hospitalized for a second heart attack. This time, as a medical student, I knew the right questions to ask to understand his condition and prognosis. (He’s now fully recovered and doing well!) Knowledge is power and understanding the biology behind a medical condition can make a situation that is out of your control, like a hospitalization, feel less scary. 

Let’s take a deeper dive into the disease process and diagnostic measurements behind each type of ACS to give you the power that comes with knowledge. 

As I mentioned in the previous section, ACS involves coronary arteries that start out as partially blocked and progress to becoming fully blocked. To understand what they are blocked by and how this happens, I need to introduce a new word: atherosclerosis. “Sclerosis” originates from the Greek and refers to the stiffening of a body part, in this case, the arteries. Atherosclerosis is a complex process that leads to the stiffening of the arteries and ultimately a blockage begins to form that prevents the heart from receiving the oxygen it needs to beat, leading to ACS, widely known as a heart attack. 

The blockage stems from the inner lining of the blood vessel wall and is composed of a core of cholesterol surrounded by a cap made of a protein called fibrin and smooth muscle cells. Calcium may also be deposited within the buildup, causing the stiffening of the artery. The process leading to the formation of this plaque, atherosclerosis, is thought to start with mild inflammation that disrupts the endothelial cells that line the artery wall, kicking off a cascade of molecular events that end up gradually blocking blood flow.

Once an artery is fully occluded the clock starts ticking. An organ can only suffer a lack of oxygen for so long, and a vital organ such as the heart doesn’t take well to such an insult. Without oxygen, the heart muscle begins to die. When the muscle cells die, they rupture, releasing proteins from the heart into the blood.

At the hospital, doctors are able to check the blood for a heart-specific protein called troponin. If the levels are above the typical amount, doctors will know that the heart muscle has already started to die from lack of oxygen. Elevated troponin indicates a myocardial infarction, while normal levels of troponin indicate stable or unstable angina.

Treatment: How do doctors treat heart attacks?

Doctors will treat an ACS patient with medications to dilate the blood-vessels to try to allow more blood flow and slow down the heart rate so that the heart doesn’t use up so much oxygen. Some of these medications include nitroglycerin and beta-blockers. 

Usually a fully occluded vessel will also require open heart surgery to allow blood flow back to the heart muscle, also known as reperfusion. If you’ve ever heard of a “bypass surgery” or a “triple bypass” you have heard about a coronary artery bypass graft procedure known as CABG. In this procedure a cardiothoracic surgeon takes a small piece of vein from the patient’s leg and stitches it around the occluded vessel to allow the blood to flow through a new path. A triple bypass means three vessels were occluded and reperfused this way. Surgeons may alternatively opt to insert a stent. This method of reperfusion involves inserting a small metal mesh in the shape of a tube into the artery to hold it open allowing blood to flow through the original artery without a graft. 

Many patients post-open heart surgery must stay in the hospital to recover and are then referred to cardiac rehabilitation to bring them back to a more heart healthy state. 

Signs and symptoms: Are they having a heart attack? 

Now that you know exactly what is happening during a heart attack and what leads up to it, let’s talk about how you can recognize a heart attack in men vs women. 

Many are familiar with the association between crushing chest pain and sometimes pain that radiates to the left arm. Other typical symptoms include difficulty breathing, lightheadedness, and weakness. These features are more typical in men, but we don’t always see this classic presentation, especially in women. Other signs to look out for are pain radiating to the right arm or the jaw, profuse sweating (called diaphoresis), nausea, vomiting, and upper abdominal (called epigastric) pain. Risk factors may differ between men and women due to differences in social pressures.

Because men typically show the classic symptoms while the symptoms of women are usually more vague, don’t be too quick to rule out the possibility of a heart attack in women over age 50 years. 

If you suspect someone is having a heart attack, it is imperative that they arrive at the emergency department as soon as possible to minimize the damage done to the heart.

Risk Factors: Who is at high risk for a heart attack? 

A family history of heart disease can point to increased susceptibility to heart attacks as factors like how your body stores and processes cholesterol can be passed down. There may also be other inheritable traits leading to heart disease that are poorly understood, however the data shows a strong correlation between heart disease in first degree relatives (think mom, dad, sister, brother, or child) and oneself. If you’re not sure of your family history, consider giving a family member a call.

While it’s important to take this factor into account, other risk factors are modifiable, meaning you can change your behavior to decrease them. The most common modifiable risk factors among both men and women include obesity, poor diet (low in fruits and vegetables), high cholesterol, stress, and smoking. In women, high blood pressure, diabetes, low physical activity, and moderate alcohol use were more commonly tied to risk for heart disease than in men. 

Prevention: Steps you can take to protect your heart health

Take control of your health by following these tips to lower your risk for heart disease.

Nutrition: Adequate fiber intake is an essential part of any healthy diet. 

Exercise: The American Heart Association recommends a minimum of 30 minutes of moderate intensity activity five days a week for adults. Moderate activity includes power walking, walking on an incline outside or on a treadmill, a light jog, or any activity that elevates your heart rate above your resting level. Breaking a sweat, but still being able to hold a conversation is a great rule of thumb for assessing if your activity is at a moderate level. Keep in mind, the AHA’s recommendations are the minimum recommendation. The higher you can raise your heart rate for a longer period of time or more days per week, the stronger you can condition your heart to be. 

Weight loss: As obesity and low physical activity are risk factors for heart attacks, it follows that weight loss can be a pivotal step towards achieving a healthy heart. If diet and exercise are proving to have a minimal effect on your weight loss, consult with your doctor to find out if a prescription weight loss medication like Weygovi could be right for you. Be sure to check in with your health insurance to see if this solution is within your budget. 

Medication: If you have previously been diagnosed with high blood pressure or high cholesterol talk to your doctor about anti-hypertensive drugs or cholesterol lowering drugs that may be of benefit to you. And if you haven’t been diagnosed with either, this is your reminder to get in your primary care doctor’s office for your yearly wellness check-up to check that those lab values have stayed within the normal range!