Welcome to Mayo Clinic podcast. Our topic today is heart attack symptoms in women — are they different from men? I'm your host, Rich Dietman.

The most common symptom of a heart attack in both men and women is some type of pain, pressure or discomfort in the chest. But chest pain isn't always the most severe or even the most prominent symptom in women, and since more women than men die each year of cardiovascular disease, we thought it important to get the facts about heart attack symptoms in women. Here to help with that is Dr. Sharonne Hayes. Dr. Hayes is a cardiologist at Mayo Clinic, and she's also the director of the Women's Heart Clinic at Mayo, and she serves on the advisory board of WomenHeart, the national coalition for women with heart disease. Dr. Hayes, thanks for being with us.

Dr. Hayes: Thanks for asking me.

Rich Dietman: Some of our listeners might be wondering why we're talking about heart attack symptoms specific to women. Isn't a heart attack a heart attack whether it happens to a man or a woman?

Dr. Hayes: Well, in a sense, a heart attack is a heart attack, because a heart attack is defined as part of the heart muscle dying because of lack of blood flow, so it usually means a blockage in the heart artery, but how it comes about in the development of coronary heart disease as well as at the time of a heart attack may look different between a man and a woman. The endpoint is the same, though.

Rich Dietman: So the symptoms are different. And as long as we're talking about symptoms, What are the most common symptoms of a heart attack?

Dr. Hayes: As you mentioned, the most common — probably 70 percent of people will have some type of symptom in their chest, but it may not be pain. So they may experience it as pressure or burning, and it may radiate up to their shoulders, or jaw or neck or back. Then, also many people will get shortness of breath. They'll get nausea. They'll get maybe even vomiting and think they have the stomach flu. They may get real sweaty and clammy and a cold sweat, have palpitations or feel lightheaded. So other patients will not have much chest pain at all, and they'll just have discomfort or pressure in their back or between their shoulder blades. So there's this wide range of symptoms that people need to be aware of. It's not like that Hollywood heart attack where somebody clutches their chest, falls over in the street — that actually happens in less than 5 percent of patients.

Rich Dietman: So are there some symptoms that a woman can be on the lookout for that are more specific to a woman when it comes to heart attack?

Dr. Hayes: So the answer to that question is, are there women symptoms? Not really. Although, when we look at the wide range of symptoms, women may be more likely to have pain not in their chest, maybe in their shoulders or between their shoulder blades and more GI symptoms, meaning nausea or vomiting or feeling an upset stomach. There are still a lot of men who have that and a lot of women who have classic chest pain, so I think that when we're looking at this we just need to know what everything, what all the symptoms are.

Rich Dietman: So why is it that there's all this talk in recent years about the difference between men and women when it comes to heart attack symptoms?

Dr. Hayes: Well, 40 years ago we thought that only men had heart attacks, that women were immune, and obviously that's not true. And so, but because of that misconception, we enrolled only men or very few women in most of our clinical trials. So a lot of the knowledge that we have in how we practice on a day-to-day basis and take care of patients is based on studies that were almost exclusively made up of men. Now that women have been included in a few more studies, we realize there are differences that we need to take into account. Some medications work better or worse or differently in men. Some tests that we do have to be interpreted differently, depending on whether you're a man or a woman. And now we know that there are some symptom differences between men and women, but the studies are pretty weak and so they're not definitive. And I think we need to study this more.

Rich Dietman: So the data just simply wasn't there.

Dr. Hayes: Exactly.

Rich Dietman: Is it true that women are more likely to die of a heart attack than a man?

Dr. Hayes: It's definitely true that women are more likely, and particularly younger women. A man and a woman have a heart attack at around age 70, their likelihood of surviving it is about equal, but a younger woman, who's 45 or 50, has two to three times the likelihood of dying from that heart attack. And overall, more women than men have died each year since 1984 of heart disease.

Rich Dietman: Why is that?

Dr. Hayes: Well, that's a great question. Again, a research lack that we don't completely understand. Part of it may be it's tougher to diagnose a younger woman. The cause of a heart attack, perhaps in a premenopausal woman, may be different. It may be due to — different than it is in older people. It may be also that we know that 80 percent of women who are under the age of 40 who have a heart attack are smokers, so it may be that those younger women have more risk factors.

Rich Dietman: Why would it be harder to diagnose, especially a younger woman, than a man?

Dr. Hayes: Well, if a younger woman walks into the emergency room, or is carried into an emergency room, even having fairly classic symptoms, the health care team might not think, "Oh gee, I wonder." Even though she's having symptoms, she might not think, "Gee, I might be having a heart attack." And the health care team might not because we're not used to and it's a preconception. In addition, those younger women may have even more of those non-classic, non-chest pain symptoms.

Rich Dietman: So it isn't quite as clear-cut, at least in terms of, perhaps preconceived conceptions of what the patient should be presenting with?

Dr. Hayes: Right. I think that, I have a number of young women who had heart attacks in their 30s and 40s in my practice, and many of them tell me that their doctors told them, "Well you look too healthy to be having a heart attack." And so, again, as the risk factors in this country increase — diabetes, obesity — we need to realize that the rate of heart attacks in both younger women and younger men is going to increase. And so the face of heart disease may be a bit different.

Rich Dietman: So what should a woman do who is not having these classic symptoms? Maybe she's got some nausea, feeling lightheaded, it's definitely not the television version of the chest tightness and all that sort of thing, but she's concerned that this might be a heart attack. What should she do?

Dr. Hayes: Well, I think she should ask herself a few questions. First of all, if this is a new symptom that she's never experienced before and it's lasting more than a few minutes and (she) feels unwell, she may want to call her doctor, and if she's feeling particularly unwell, just calling 911 and going to the hospital. On the other hand, if this is a symptom that's kind of like something she's had before, and an antacid has worked for it, it's OK to try the antacid, or try that, and see if that works, because if that makes it go right away, then probably she's right. I think women need to have sort of a gut feeling and not put off or not pay attention to new symptoms that are either worsening or waxing and waning and not going away. I tell women, better safe than sorry. It's much better to walk out of the emergency room being told that you had a bad case of indigestion than not making it to the emergency room, having had a heart attack.

Rich Dietman: So, a woman gets to the emergency room. What should she do when she gets there and she feels that perhaps she's not being taken as seriously as she should be when it comes to heart attack symptoms?

Dr. Hayes: Well, I think if she came to the emergency room or called 911 because she was concerned she might be having a heart attack, she certainly should tell the nurse or the doctors that are caring for her that that's why she came, because we know that not all health care providers, particularly if she doesn't look like the typical heart patient, might even be thinking about that, and ensure that she'll get tested for a heart attack. She might want to ask if she's being ruled out for a heart attack, and that can be done with an electrocardiogram and with blood tests such as troponin, which measures levels of injury to the heart muscle. So I think she should ask questions, you know, "Have you checked to see if I've had a heart attack?" I think that's perfectly legitimate for a patient to do.

Rich Dietman: So use the words.

Dr. Hayes: Use the words.

Rich Dietman: And let the ER staff decide. What can a woman do preemptively before she has a heart attack, not only to reduce her risk but also to reduce her risk of dying from one?

Dr. Hayes: Well, women have a lot of control over their risk factors and their lifestyle. They may not think they do because they often don't take the time to make the effort, but I think that women really do have a lot that they can do to reduce the risk. Obviously, if they smoke they need to stop smoking. That is the most powerful risk factor, particularly in women. For a given dose of cigarettes, it actually increases a woman's risk more than a man's risk of dying of a heart attack. If she's not a smoker, then the next best thing she can do is move more, in whatever way. Exercise might be a four-letter word, but move. Dance, walk, do whatever, and do more than she's doing now. That's the one piece of advice I can say that will actually make her feel better. Eat a healthy diet. Low or good fats, so minimize saturated fats and trans-fats, eat lots of fruits and vegetables, at least five servings a day, and keep a healthy weight. So eat enough calories to keep you at that healthy weight. Beyond that, she should know what her risk factors are, and that's going to require a visit to the doctor. So knowing what her cholesterol, and the full lipid profiles, so triglycerides, HDL or good cholesterol and LDL, or bad cholesterol. Her blood pressure and then talk with her doctor — are they at the levels that they need to be. What can I do, whether it's with lifestyle or diet or medication to lower them further and get them in the right range? And finally, talk to their doctor about, is there anything particular to my situation because of my family history or other factors — such as I'm a diabetic — that put me at particularly high risk that maybe I should have other tests.

Rich Dietman: Is it ever too late for a woman to start doing some of these things?

Dr. Hayes: Actually no. And this great data, they actually had people starting a walking program, and they looked at people who walked, or when they started their walking program, and a very large, the Nurses' Health Study, which had tens of thousands of women in it, and they found that walking about three hours a week, briskly, reduced the risk of a heart attack 30 to 40 percent. Women who started walking at age 65 had the same benefit, who'd never walked before. So it is never too late.

Rich Dietman: Thanks very much, Dr. Hayes. We've been talking with Dr. Sharonne Hayes, a cardiologist and director of the Women's Heart Clinic at Mayo Clinic. You've been listening to Mayo Clinic podcast. I'm Rich Dietman.