Why Heart Attacks in Women Get Missed So Often

Heart attacks in women get missed because the signs are quieter: breathlessness, nausea, a cold sweat, or unusual tiredness instead of crushing chest pain. In Pakistan, family duty and hesitation add more delay. Any sudden unexplained symptom like these needs 1122 or DHQ Hospital Abbottabad Emergency at once.

What are the symptoms of a heart attack in women?

Women do get the classic pressure-like chest pain during a heart attack. They are simply more likely than men to have other, less obvious symptoms alongside it, or instead of it. The American Heart Association singles out shortness of breath, nausea or vomiting, and pain in the back or jaw as symptoms women in particular should watch for.

Signs that deserve attention in a woman, especially over forty:

• Sudden breathlessness on small tasks, like walking to the kitchen
• Pressure, squeezing or fullness in the centre of the chest, even if it is mild
• Pain in the jaw, neck, back, shoulders or upper stomach
• A cold sweat with no heat and no fever to explain it
• Nausea, vomiting, or an acidity-like discomfort that antacids do not settle
• Heavy, unfamiliar tiredness over hours or days, with no clear reason
• Light-headedness, or the sense of being about to faint

The word doing the work in that list is new. A woman who managed her housework easily last month and now stops halfway to catch her breath has a new symptom, and new symptoms need an explanation rather than an assumption.

Notice also how rarely these are described as pain. In clinic, women more often reach for words like heaviness, tightness, discomfort, or simply "something is not right". A husband who is waiting to hear the word pain before he takes it seriously may wait a long time. Take the description you are given at face value and act on it.

Why are women's heart attacks missed so often?

Because everyone involved, patients, families, and sometimes health workers too, is waiting for the television version: a man clutching his chest and going down. When a woman instead feels breathless, sick and drained, nobody's first thought is the heart.

There are medical reasons layered on top of that. Women's heart attacks more often involve the smaller branches of the heart arteries, which can produce vaguer symptoms. Diabetes, extremely common in Pakistani women, dulls the nerves that carry pain, so the warning system itself is turned down. And because women tend to develop heart disease later than men, their symptoms arrive mixed in with the other complaints of age, joint pain, weakness, indigestion, and get lost in the crowd.

The result is a double delay. Women wait longer before telling anyone, and families wait longer before acting on it. The European Society of Cardiology states in its guidelines that acute heart symptoms in women deserve the same urgent assessment as in men, because the disease is exactly as deadly when it is missed. Our heart attack page explains how a heart attack happens and how it is treated.

Why do women in Pakistan delay going to the hospital?

Because in a lot of households, a woman's own health sits at the bottom of her own list. Every doctor in this country sees it, and saying so plainly is the first step to changing it.

She puts the family first

Many women will finish the cooking, serve the meal and settle the children while symptoms are running. By the time she admits something is wrong, the useful hours have gone.

She waits for permission or a companion

In many families a woman will not go to a hospital alone. If the husband is at work or the sons are away, she waits, sometimes all day, sometimes through the night. During a heart attack, that wait is the most dangerous thing in the house.

She does not want to spend money on herself

Mothers who never think twice about a child's school fees will think hard about their own hospital visit. What we hear is some version of "pehle dekh lete hain, theek ho jaye ga", let us wait and see, it will pass.

She feels shy about examination

Some women avoid the hospital because they fear being examined by male staff. Families should know that female staff work in Emergencys, that examination is done with dignity, and that in an emergency, saving a life takes precedence in every school of thought.

None of these makes anyone a bad person. Each one adds delay, and the treatment that saves heart muscle works best in the first hours, not the second day. The cruel arithmetic is that the same household will move within minutes for a child with a high fever, and hesitate for hours over a mother with a cold sweat.

What is the family's role when a woman has symptoms?

The family is the emergency system inside the house. A woman's heart attack is usually either recognised or missed by the people standing next to her. Husbands, sons, daughters and daughters-in-law should know the quiet symptoms listed above and act the moment they show up.

What acting looks like:

• Believe her the first time she mentions a symptom, without waiting for her to insist
• Call 1122 or arrange transport to DHQ Hospital Abbottabad Emergency immediately
• Skip the home remedies and the round of phone calls to relatives
• Keep her resting and calm while transport comes: no stairs, no packing, no finishing the chores
• Take her medicine list and any old ECG or reports that are within reach
• Afterwards, make sure she attends follow-up and takes her medicines, because recovery is a family project too

Here is a general example rather than a real patient. A woman in her late fifties with diabetes feels breathless and nauseated after dinner. Her daughter-in-law notices she is sweating despite the fan, remembers that this can be a heart sign in women, and insists the family go to the Emergency tonight instead of the clinic tomorrow. That single insistence is often the whole difference between a treated heart attack and a funeral.

When should a woman get her heart checked before an emergency?

Before symptoms turn into an emergency, any woman with risk factors should have a planned heart check, particularly after menopause, or at any age with diabetes, high blood pressure, high cholesterol, obesity or a family history of early heart disease. Waiting for severe symptoms is not a plan. It is a bet.

A planned chest pain evaluation is the right route for a woman with chest heaviness, breathlessness on exertion, or unexplained fatigue that comes and goes. The visit starts with a detailed history and an ECG, and may include an echocardiogram, which is an ultrasound of the heart, or other tests depending on what turns up. Dr. Muhammad Ali Khan, Consultant Cardiologist, examines women with these symptoms every week in Abbottabad, and clinics run in the afternoon and evening so a family member can come along comfortably. For women who cannot easily travel, an online video consultation is a practical first step towards deciding whether an in-person visit and tests are needed.

If a woman in your family has symptoms that worry you, or has been putting off her own check-up for years, take the step on her behalf. Book a clinic visit (Rs. 2,000) or an online video consultation (Rs. 2,500) through our appointments page.