THE BLOG
08/04/2014 01:33 pm ET Updated Feb 25, 2015

10 Heart Attack Warnings Young Women Shouldn't Ignore

According to statistics from the Heart Foundation, 435,000 American women have heart attacks annually and 267,000 die from them. Of these deaths, 83,000 are in women under age 65; 35,000 are in women under 55.

Recently a study published in the Journal of the American College of Cardiology reported that heart attacks are more fatal for young women ages 30 to 54 than they are for men. Researchers from Yale University found that from 2001 to 2010, 2 to 3 percent of women between the ages of 30 and 54 who were hospitalized for a heart attack died, compared to 1.7 to 2 percent of men in the same age group.

I am not surprised at these findings. For years women in the throes of a heart attack have been misdiagnosed, and often sent home from the ER, because their symptoms were not of the classic "elephant sitting on my chest" variety. To make matters worse, women often wait longer than men to go to the ER because they don't believe their symptoms are real or they don't want to bother anyone. And once they are admitted, studies show they also wait longer than men to be treated. (This is important because the odds of surviving a heart attack are improved by 23 percent if you get treatment within three hours and by 50 percent if you get treatment within an hour.)

You're never too young or too healthy to have a heart attack. And women must not let doctors dismiss the subtle signs and symptoms. If you think you're having a heart attack, call 911 immediately and make sure to follow the operator's instructions. Do not drive yourself or have someone drive you to the hospital unless you have no other choice. Try to stay as calm as possible and take deep, slow breaths while you wait for the emergency responders. Also, crush or chew a full-strength uncoated aspirin (swallow with a glass of water) to prevent further blood clotting. Once you get to the ER, do your best to emphatically say, "I think I'm having a heart attack," and insist on seeing a doctor within 10 minutes. Make sure you get an EKG to check your heart function, plus blood tests to detect heart damage. Do not leave the hospital until you've been seen.

Here are 10 warning signs women of all ages should never ignore. Keep in mind that often these symptoms can occur weeks or even months leading up to a heart attack.

1. Non-chest pain. Pressure, tightness, tingling, aching, or burning in your upper back, shoulders, arms, or even in your neck, throat, jaw, and ear, can be signs of heart distress. It may feel like backache or a pulled muscle or like arthritis or a pinched nerve, but if you have these symptoms and they don't go away, you need to rule out a heart attack first. If the pain is in your jaw and it's constant, it's likely a dental problem. If it's intermittent and gets worse upon exertion, it's likely heart related since the nerves of the jaw and heart lie close together.

2. Shortness of breath. If you find that you're panting or breathless or have a racing heart rate while walking up the stairs or doing other daily activities, or you can't even carry on a conversation without losing your breath, it could be the sign of a heart attack. Some women say they feel like they've just run a marathon even though they haven't moved. Keep in mind that these symptoms could also be the result of a pulmonary condition like COPD or asthma, or of a panic attack. But panic attacks usually come on suddenly and generally pass within five minutes. Breathlessness that starts slowly and lingers should not be ignored.

3. Extreme or unusual fatigue. More than 70 percent of women in a study published in the journal Circulation reported extreme fatigue in the month or months prior to their heart attacks. This isn't your usual fatigue from missing sleep or having the flu or burning the candle at both ends. Rather, you are so tired all the time that you can barely walk down the street or do daily activities without resting. This could mean that blood is not getting to your heart fast enough due to a blockage.

4. Sweating or feeling overheated. If you suddenly find yourself drenched in a cold sweat for no apparent reason (and you know it's not a hot flash), it could be the symptom of a heart attack.

5. Anxiety. Many women experience a sense of impending doom or fear moments before or during a heart attack. They're aware that something is drastically wrong, but they don't know how to deal with it. Too often women attribute this to stress rather than a heart attack, because their lives are so pressured.

6. Dizziness or lightheadedness. Feeling faint and shaky for no obvious reason could mean that not enough blood is getting to your heart. Pay attention to this symptom, particularly if you're also suffering from shortness of breath and a cold sweat.

7. Nausea/vomiting. Waves of nausea, stomach ache, cramps, vomiting and/or diarrhea are often reported by women who are having a heart attack. If nausea or vomiting comes along with other heart attack symptoms like shortness of breath, a cold sweat, or pain in your chest, back, or extremities, then you can be pretty sure it's not due to food poisoning or the stomach flu.

8. Indigestion or stomach pain. Because indigestion can cause the chest pain and burning known as heartburn, it can be confused with symptoms of a heart attack. Heartburn pain usually comes after meals, and it responds quickly to antacids or belching. It generally doesn't radiate to the shoulders, neck, or arms, although it can. If the pain persists and is accompanied by a cold sweat, lightheadedness or dizziness, or it feels like an elephant is sitting on your stomach, then it could be a heart attack.

9. Prolonged insomnia. In the days or weeks before a heart attack, many women have unexplained insomnia. They described it as feeling "wired" or having racing thoughts before falling asleep and then waking frequently and not being able to fall back to sleep. Chronic sleep deprivation can raise blood pressure and reduce your body's sensitivity to insulin, both of which can damage the heart and lead to heart attack.

10. Chest discomfort. Heart-related chest pain is often centered under the breastbone, perhaps a little to the left of center. This last symptom is the most similar to a man's traditional heart attack, except women tend to describe it as a minor ache, a heavy weight compressing their lungs, or as a burning in their chest (see #1). If chest discomfort persists, it should not be ignored.

As a cardiologist for more than 25 years, I know that heart attacks don't have to happen. While there isn't much you can do to change bad genes, there is plenty you can do to change your lifestyle. This begins with quitting smoking (the worst thing you can do for your heart and your health), improving your diet and losing weight, if necessary, by eating plenty of vegetables, whole fruits, whole grains, as well as lean protein and good unsaturated fats, and getting at least 20 minutes of cardio or core-strengthening exercise most days of the week. Also, don't spend long hours sitting in front of TV and computer screens. Stand at your desk when you can, to break up periods of sitting. It's also important to reduce stress in your life, get at least seven to eight hours of sleep each night, and monitor your alcohol intake. Finally, take advantage of the best single predictor of a future heart attack -- the CT scan for coronary calcium (ask your doctor about it). It could save your life.

Arthur Agatston, M.D., is the Medical Director of Wellness and Prevention for Baptist Health South Florida. A pioneer in cardiac disease prevention, he is author of The South Beach Diet; there are more than 23 million copies of The South Beach Diet and its companion books in print worldwide, including The South Beach Heart Health Revolution and The South Beach Diet Wake-Up Call. Dr. Agatston has published more than 100 scientific articles and abstracts in medical journals and is a frequent lecturer across the U.S. and around the world on diet, cardiac imaging, and the prevention of heart disease. He can be found on the Web at SouthBeachDiet.com and EverdayHealth.com and he is also an advisor on heart health for Prevention magazine. His cardiology practice in Miami Beach is focused on preventing heart attacks in high-risk patients.

For more by Arthur Agatston, M.D., click here.

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