WE all know what a heart attack looks like — someone claps a hand to their chest and collapses, right?
Wrong — or, at least, partly wrong, because while a sudden and severe chest pain is a classic symptom of heart attack for a man, it’s not always the same for a woman.
In fact, warns consultant cardiologist Dr Robert Kelly, heart disease red-flags for women can be quite subtle and gradual — and, shocking as this may sound, when they come, many women don’t even recognise them.
And that’s partly because although it’s the number one cause of death for women globally, heart disease is often perceived as a male problem, he says.
“It’s often seen more as a male issue and part of that is historical; the other part is that although women are very good at getting their partners to seek help, they’re poor at seeking it for themselves,” he explains.
Furthermore, Dr Kelly says women may fail to recognise symptoms of heart disease in themselves because they can be very different to the more dramatic symptoms often experienced by men.
A woman may simply notice that she is feeling unwell or fatigued, is experiencing indigestion that is not related to eating and not resolved by indigestion medication, vague chest and back discomfort, dull pain in the left arm, or shortness of breath — and may never connect the dots and realise she may have a heart problem.
Heart problems were the last thing accountant Mary Maher dreamed of — she’d never had issues with high blood pressure, risky cholesterol levels, or chest pain.
When she sought medical advice for a painful shoulder, the busy mother of two, from Tullow, Co Carlow, never dreamed she’d end up being sent for an angiogram or that she’d be told she had a 50% blockage in her coronary artery or realise that she needed medication and a dramatic lifestyle change.
But that’s what happened back in 2014 when, then aged in her mid-50s, she saw a consultant about a frozen shoulder: “This is a painful condition because the tendons in the shoulder stop working and the shoulder tightens up,” she says.
Maher has run her own accountancy practice for 16 years.
“I ended up having a number of minor surgeries on the shoulder, and I noticed that after these surgeries I didn’t feel well,” recalls the 57-year-old.
After the third surgical procedure, she felt so unwell that her consultant felt there might be an underlying problem.
He referred her to a cardiologist who immediately ordered an angiogram.
“I had an angiogram the next day and he found a 50% blockage. I’d had no symptoms of any heart problems at all.
“I was very lucky that the frozen shoulder brought me to the attention of a cardiologist,” she says, adding that around that time she was juggling the stresses of a demanding job with the recent death of her father.
If she hadn’t sought treatment for the frozen shoulder she now believes she could have simply continued on in day-to-day life until the blockage in her coronary artery became highly dangerous.
Instead, she got a serious shock, was placed on medication, and started to attend a weight-loss clinic.
“I changed my lifestyle and lost three stone in weight. I also exercised more,” she says, adding that she now goes to the gym twice a week, attends pilates once a week, and hill walks regularly. She also started to consciously manage her stress levels.
“I feel much healthier than I did 10 years ago. I find exercise helps with stress and I am more mindful about managing stress.
“I am monitored regularly and my cholesterol and blood pressure levels are perfect.
“I will probably have to take the medicine forever but the combination of medication and lifestyle has really seen the problem recede. I am not a fitness fanatic but I have come to see the benefits, health-wise and stress-wise, of regular exercise.”
There is a common perception that heart health is primarily a male issue, says Janis Morrissey, acting health promotion manager at the Irish Heart Foundation.
In a study of more than 1,000 adults aged over 18, carried out in 2015 by the Irish Heart Foundation, she says, only one in 10 women believed that heart disease was the number one killer of Irish women.
The survey found that cancer was actually perceived to be the main problem.
Morrissey says the research also showed that as many as one in five women believed breast cancer was the top killer of women.
“The reality is that women are six times more likely to die of heart disease and stroke than of breast cancer so there is a big gap between perception and reality.”
Post-menopause women are as much at risk of heart disease and stroke as many men but are often not aware of it, she says.
However, the good news is that 80% of heart disease and stroke is preventable with a healthy lifestyle.
“We also know that the signs of heart disease in women can be different to men — they are vaguer — so they can experience nausea, tiredness, shortness of breath, and can delay going to hospital and lose valuable treatment time,” she warns.
In fact, public awareness of the risk posed to women’s health by heart disease is so poor that many women express surprise on hearing about it, says Patricia Hall, the IHF’s helpline nurse manager.
“A lot of women come to the helpline asking about the symptoms of heart disease in terms of their male partners.
“They are quite surprised when we alert them to the risks and warnings signs peculiar to women.
“This whole idea of women not thinking they’ll get heart disease is a phenomenon. Breast cancer is much more in their minds as a risk.”
Dr Kelly, a consultant cardiologist at the Beacon Hospital, agrees.
He points out that modern lifestyle issues — more women smoking, higher consumption of alcohol by women, particularly of wine, which is high in sugar — contribute to the risk of heart disease for women.
Other issues such as high blood pressure, high cholesterol, overweight, inactivity and stress all exacerbate the potential risk.
“Weight is a big problem, and one of the big issues around weight is that a lot of women are not dealing with it,” says Dr Kelly, adding that because they may not realise it is a risk, and because they don’t recognise their symptoms, women can present relatively late with heart disease.
“Symptoms come on over a period of time and women get very busy and don’t make time to go and see the doctor. A lot of women are feeling unwell or fatigued, and they do not necessarily get the classic symptoms such as chest pain.
"They tend to present with a variety of symptoms, for example, pain in their back, and part of the problem may be a lack of awareness that a heart problem could be at the root of why a woman may not be feeling well.
If you want to be there for your grandchild’s birthday, he says, the key is to look after yourself, keep your weight down, drink less alcohol, and don’t smoke — in that case, he declares, the chances are that you will make it.
“It often comes down both to not looking after yourself and not looking out for yourself in terms of prioritising your own health.”
For more information visit the Irish Heart Foundation’s Women and Heart magazine at www.irishheart.ie
- Be active — at least 30 minutes of aerobic activity five times a week.
- Eat a healthy diet. Eat more fruit and vegetables and fresh foods; eat less fat, fries and convenience foods.
- If you smoke, stop. The risk of heart attack is reduced by half, one year after quitting.
- Have regular blood pressure and cholesterol checks with your family doctor.
- Know your family history and the signs and symptoms of heart disease.
- Go easy on alcohol. No more than 11 standard drinks per week.
- Enjoy life. Take time out for yourself and keep in touch with friends.