A Woman's Guide To Having Heart Attacks

Source: New York Times
It’s called the “Hollywood” heart attack. You’ve seen it: the grimace of agony, clutching of chest, sudden collapse…the way heart attacks are supposed to happen…(But) mine went like this:
Altogether well one moment, vaguely unwell the next; fluttery sensation at the sternum, rising into the throat; mild chest pressure; then chills, sudden nausea, vomiting, some diarrhea. No high drama, just a mixed bag of somethings that added up to nothing you could name. Maybe flu, maybe a bad mussel, maybe too much wine…
Still, that pressure, slight but there, nagged at me. I called my doctor and reported my symptoms. The mention of diarrhea, almost never a presenting symptom in heart attacks, skewed the picture. He said, “It doesn’t sound like your heart. I can’t say a thousand percent that it’s not, but it doesn’t seem necessary to go racing to the emergency room with the way you feel now. Just see it through and come in for an EKG in the morning.”
The pressure eased. I slept, and woke the next morning feeling well. I went for the test mainly because I had said that I would, fully expecting to be told that I was healthy. First the EKG and then the echocardiogram told a different story: a substantial heart attack, “less than massive,” my doctor said, “but more than mild.” We were both stunned…
(M)en more typically have “crushing” pain; women, nausea…Women are likelier to have early warning signs, such as unaccustomed fatigue or insomnia (unaccustomed: that’s the key word here)…
(O)ur symptoms can be so varied and nuanced that we feel no fear, seek no help, and possibly die — which may be why, although more men have heart attacks, a greater percentage of women die of them…A nurse practitioner offers a graphic tutorial…

(S)he…puts one hand beneath her nose, as though in salute, and the other at her pelvis, and says, “In women, from here to here, anything could be a symptom.” Thus encompassing jaw, neck, throat, back, shoulders, chest, arms, diaphragm, abdomen…

Until this millennium, there was minimal research on women’s heart attacks because of widespread belief in the medical community that women did not have heart attacks…Research studies commonly used all-male subjects…Women reporting the same symptoms as men were at least twice as likely to receive — no surprise here — a psychiatric diagnosis…
What we already know is that nearly a half-million women are stricken annually by heart disease. That it is crucial to get help fast. That symptoms can include neck pain, shoulder pain, back pain, belly pain. But what we are still not told is how to know when back pain, that endemic American complaint, is a possible warning sign.

Here my doctor supplies a missing nugget of common sense: “Don’t be reporting every little kvetch — use discretion. But if it is a symptom unlike any you have experienced before, make the call. Get a reality check.”

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