PHOTO: SHUTTERSTOCK

When you think about heart attack symptoms, the mental image of an elephant sitting on your chest may come to mind.

While chest pain and any variant such as chest pressure, chest tightness or chest heaviness is the most common presenting symptom of a heart attack, women sometimes have “atypical symptoms” as well, says Dr. Malamo E Countouris, an assistant professor of medicine and the director of the Clinical Scientist Track in the Internal Medicine Residency Program at the University of Pittsburgh. 

“These can include even just shortness of breath,” she says. “It could be nausea or even vomiting, sometimes a blushing sensation in the face or like a pain that radiates to the jaw or the left arm. Those kinds of less-typical symptoms we are more likely to see in women, and so you’re really trying to keep an open mind.”

As for when to take symptoms seriously, she notes chest pain and tightness should be addressed with a doctor right away.

“But it also depends on sort of the suddenness of onset,” she says. “If something comes on really quickly and it’s very intense, then that might be a situation where you want to go to the ER versus something that has been kind of gradually worsening or maybe comes and goes, doesn’t last a long time, is not super intense. Typically, physicians will take chest pain pretty seriously.”

If a woman experiences a combination of symptoms that come on suddenly, for example nausea and jaw pain and flushing in the face, that’s also something they should take seriously, she says.

Risk factors for heart disease are different for women patients, too.

“There’s the typical things that we think about like high cholesterol, hypertension, diabetes, obesity, but there are unique risk factors to women, and there are risk factors that we see more commonly in women,” she says.

Complications related to pregnancies including hypertensive disorders of pregnancy, preeclampsia and gestational hypertension, gestational diabetes and preterm birth increase a patient’s risk for heart disease down the line. Early menopause (menopause that starts before age 45) is another risk factor for women. 

Countouris also notes certain treatments for breast cancer such as radiation to the left chest or chemotherapy can accelerate the progression of cardiovascular disease, and inflammatory disorders more common in women like rheumatoid arthritis and lupus are also associated with an increased risk of cardiovascular disease.

Getting enough exercise, eating a heart-healthy diet, quitting smoking, getting enough sleep and keeping stress low are ways women can help to keep their heart healthy, Countouris says.