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Are You at Risk for a Heart Attack?

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How to Recognize a Heart Attack

Not every woman who has heart disease will undergo an attack, which occurs when the heart is deprived of blood and oxygen, usually from a blockage in the artery. But women who do suffer one are more likely than men to die of it, in part because women don't always have the easily recognizable, chest-grabbing, arm-clutching symptoms. That may be why it takes a woman having a heart attack a full 20 minutes longer than a man to get to the ER; once there, she may not get the prompt care she needs. In a 2004 study, women receiving an emergency procedure to reopen clogged vessels had to wait an average of 118 minutes before being treated; men waited approximately 105 minutes.

Ongoing research on more than 1,500 female heart-attack victims by Jean McSweeney, RN, PhD, of the University of Arkansas for Medical Sciences, is giving us a clearer picture of their key symptoms. Instead of the left-sided chest and arm pain that men describe, generalized discomfort in the chest, breast, back, shoulders, neck, or throat may be more likely to affect some women, says McSweeney. "The most common heart-attack warning sign among our subjects is unusual fatigue," she says. "We had one woman who told us that she had to sit down and rest between making the left and right sides of her bed." Shortness of breath, anxiety, and nausea were other common symptoms for McSweeney's subjects; in recent research done at Yale University, jaw pain also afflicted many women. Finally, in the days leading up to an attack, many women report sleep disturbances and severe indigestion.

Some women suffer these symptoms, especially fatigue, for months before a full-blown heart attack, says McSweeney. Sometimes doctor oversight is to blame. For a long time, physicians were taught to envision a heart-attack victim as either a man clutching his chest or as an elderly woman, says Suzanne R. Steinbaum, DO, director of women and heart disease at the Heart and Vascular Institute of Lenox Hill Hospital in New York City. For a year and a half before her heart attack 12 months ago, Judi Roach had been seeing her internist for breathlessness, exhaustion, and a racing pulse, which were attributed to her allergy medication, fatigue, and stress. "It never entered her mind that a 34-year-old could be having heart-related problems," says Roach, who, ironically, wrote herself a note to "call a cardiologist" for a second opinion two weeks before the event.

Other women survive an attack and don't even know it. Nadine Jenkins was 34 when she mentioned to a nurse at the hospital where she worked as an administrator that her heart had been "skipping a beat." Her friend hooked her up to an EKG machine, which revealed atrial fibrillation, a relatively common condition in which the heart's two small upper chambers quiver instead of beating effectively. When she followed up with a cardiologist, the doctor did additional scans to investigate further. "At one point, she peered at the screen, raised her eyebrows at her assistant and then said to me, 'Do you realize you've had a heart attack?'" says Jenkins. "The scarring revealed it, but I couldn't tell her when it had happened." Jenkins was diagnosed with an enlarged heart and ventricular tachycardia, which can cause the heart to fall suddenly into a "deadly rhythm." She now wears a defibrillator, which shocks her heart back into the appropriate beating pattern whenever it gets out of sync. "I don't smoke, I don't drink, I'm of average weight -- people can't believe I have heart disease, and I guess I couldn't either. Who knows what would've happened had I not said something to a coworker who knew enough to look into it?"

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