Ask an Expert: Women's heart attack symptoms and what to do

Q: A friend forwarded an e-mail to me about what to do if you're alone and you think you're having a heart attack. It says that coughing hard will squeeze the heart and keep the blood flowing until you can get help. It also says that women may experience strange symptoms, like a pain in the jaw, instead of chest pain. Is any of this true?

Answer provided by Suzanne M. Hall, M.D., F.A.C.C., medical director of the Women's Cardiovascular Program at Providence Heart and Vascular Institute, and cardiologist with Columbia Cardiology Associates: I looked at the e-mail (below), and while the facts and recommendations in it are far from perfect, I do like that it's talking about women and heart attacks.

Most women, and even many of their physicians, don't consider women as being at high risk of heart disease, even though it is the number one killer of women in the United States. In fact, according to estimates from the American Cancer Society and the American Heart Association, heart attacks and strokes take the lives of far more women every year than lung, breast and colorectal cancers combined.

I want women to know that they (or a companion) should call 9-1-1 if they ever feel a strange, new discomfort in their chest or if they experience any of the symptoms described later in this article.

If you wait out the discomfort of a heart attack for a few hours, the discomfort goes away -- because the affected heart muscle has died. So don't wait it out. The more quickly you seek medical treatment, the more heart muscle you'll save. Time is heart muscle.

Here is the e-mail. More of my comments follow.

___________________________

Heart Attack Procedure: NOT A JOKE

(The sender's introduction):

Women should know that not every heart attack symptom is going to be the left arm hurting. Be aware of intense pain in the jaw line. You may never have the first chest pain during the course of a heart attack. Nausea and intense sweating are also common symptoms.

Sixty percent of people who have a heart attack while they are asleep do not wake up. The pain in the jaw happened to me and woke me from a sound sleep. I was one of the fortunate ones. Trust me when I tell you it's pain unlike anything you've ever experienced before. Given a choice between natural child birth and a heart attack, pain-wise; it's much easier to have a baby.

Let's be careful and be aware. The more we know...

(Forwarded e-mail):

A cardiologist says if everyone who gets this mail sends it to 10 people, you can be sure that we'll save at least one life. Read this... It could save your life!!

Let's say it's 6:15 p.m. and you're driving home (alone of course), after an unusually hard day on the job. You're tired, upset and frustrated. Suddenly you start experiencing severe pain in your chest that starts to radiate out into your arm and up into your jaw. You are only about five miles from the hospital nearest your home.
 
Unfortunately, you don't know if you'll be able to make it that far. You have been trained in CPR, but the guy that taught the course did not tell you how to perform it on yourself.

HOW TO SURVIVE A HEART ATTACK WHEN ALONE
 
Since many people are alone when they suffer a heart attack, without help, the person whose heart is beating improperly and who begins to feel faint, has only about 10 seconds left before losing consciousness. However, these victims can help themselves by coughing repeatedly and very vigorously. A deep breath should be taken before each cough, and the cough must be deep and prolonged, as when producing sputum from deep inside the chest.

A breath and a cough must be repeated about every two seconds without let-up until help arrives, or until the heart is felt to be beating normally again. Deep breaths get oxygen into the lungs and coughing movements squeeze the heart and keep the blood circulating.

The squeezing pressure on the heart also helps it regain normal rhythm. In this way, heart attack victims can get to a hospital.

___________________________

 

What's missing?  

The most important advice missing from this e-mail is the advice to call 9-1-1 immediately if you suspect you are having a heart attack.

Heart attacks occur when oxygen-rich blood hits an obstacle -- nearly always a blood clot -- as the blood moves through an artery leading to the heart. The clot plugs the artery, either completely or almost completely.
 
Without nourishment from a sufficient blood supply, the heart muscle becomes damaged. The idea is to get medical help before this damage occurs.

If you are driving alone and feel symptoms of a heart attack (more on symptoms in a bit), I say: Pull over. Use your cell phone to call 9-1-1, or flag a passing car or person. Put your energy into getting help.

After you summon help, lie down (this helps prevent lightheadedness) and, if possible, take an aspirin (either one adult aspirin or, even better, two low-dose chewable aspirins, because the chewables enter your system faster).
 
The goal is to get to a hospital, fast, in an ambulance. The expense of an ambulance is worth it because paramedics or emergency medical technicians can start treatment enroute.

Can coughing keep blood circulating while you wait for help?

This is kind of a bogus recommendation that can leave patients with a false sense of control. You can't cough your way out of a heart that's fibrillating. "Fibrillating" means the heart is beating in such a disorganized fashion that it has lost its ability to effectively pump blood.

(You may hear of some people dying within minutes after suffering a heart attack. In reality, these patients died because the interrupted flow of blood -- the true heart attack -- triggered another problem: arrhythmia, or disruption of the heart's normal rhythmic beat. Ironically, patients can die from arrhythmia much more quickly than they would from the heart attack that caused the arrhythmia. This is another reason for calling 9-1-1 as quickly as possible. The paramedics can use a defibrillator to try shocking the heart back to its normal beat.)
 
The e-mail is mixing up a heart attack -- a plugged artery that can lead to damaged heart muscle -- with a heart that's "beating improperly," i.e., a rhythm problem. Rhythm problems can occur in otherwise healthy patients who have no coronary artery disease, and they can occur as a consequence of a heart attack. But they are not a type of heart attack.

This is a complicated subject, but basically, coughing has the potential to help only if you are experiencing a certain kind of palpitation -- a rapid, fluttery ventricular (bottom chamber of the heart) rhythm that's different from fibrillation. Call 9-1-1, or ask someone to call for you.

After calling 9-1-1, if you're starting to lose consciousness (a sign of arrhythmia), yes, you can try coughing to help restore an even rhythm. Don't bother learning how to cough in some fancy way.

Despite what the e-mail says, coughing does not squeeze the heart. CPR (cardiopulmonary resuscitation) squeezes the heart. The reason the CPR instructor didn't teach how to self-administer CPR is because you can't effectively perform CPR on yourself.

Are women's heart attack symptoms different?

Women certainly can experience any of the classic heart attack symptoms:

  • A heavy weight on the chest
  • A heartburn-like sensation
  • Discomfort in one or both arms
  • Shortness of breath
  • Cold sweatiness
In addition, both men and women can experience what we call atypical symptoms -- symptoms you might not immediately associate with a heart attack. However, atypical symptoms are far more likely in women. These symptoms may include the following: 
  • Pain or discomfort in an odd spot, such as the jaw, elbow or a tooth
  • An unexplained sense of doom or anxiety
  • A vague feeling that something isn't right
  • Sudden weakness or deep fatigue (some women confuse this with the flu)
  • Shortness of breath
  • Nausea
Whether typical or atypical, heart attack symptoms can hit hard and fast, or they can present themselves slowly and build in severity over the course of an hour or two.

How can a heart attack make your jaw hurt?

We're all put together a little differently. These individual differences include the pathways of nerves leading from our internal organs. Depending on your own nerve pathways, you may experience "referred pain" --  pain that originates in one part of the body but is felt in another.

During a heart attack, although your body's distress signals may originate in the heart, your nerve pathways may refer the pain to your jaw, your elbow, or even a tooth -- and yes, the discomfort can be severe enough to wake you up from a sound sleep.

Is a heart attack more painful than childbirth?

I've never had anyone tell me that a heart attack is more painful than childbirth. In fact, cardiologists shy away from the word "pain," because the sensations associated with heart attacks are not sharp, nor do they come in intense waves like in childbirth.

Heart attacks usually involve a steady discomfort that builds -- either quickly or more slowly -- from a lower intensity to high intensity. Patients describe the sensation as heaviness, achy-ness, pressure or burning.

Spread the word I am happy whenever the public pays attention to women's risk of heart disease. To help spread the word, please talk with your friends and family members about the typical and atypical signs of heart attack and the importance of calling 9-1-1.

I'd like to make a plug for prevention, too. Regardless of your current health status, you can do a lot to lower your risk of heart attack and stroke by exercising, eating a healthful diet, maintaining a healthy weight and keeping blood pressure, blood sugar and cholesterol at good levels.  

April 2006