With BP at 130/70 mmHG, pulse beat at 86, ECG normal, 37-year-old woman had a silent heart attack: What are subtle symptoms?

Gayathri had no crushing chest pain, no breathlessness, no crushing jaw or arm pain, no nausea, vomiting and certainly no anxiety or sense of doom, all classic signs of a heart attack. Along with a normal ECG, her blood pressure was 130/70 mmHg, her usual being 120/80 mmHg. Her pulse was 86. Nothing to indicate that she had a blockage in her left anterior descending (LAD) artery, the biggest supplier of oxygenated blood to your heart’s pumping chambers. On deeper investigation after we cleared the blockage with a stent, we found that she had polycystic ovary syndrome (PCOS), which often involves insulin resistance, hypertension, high cholesterol and obesity, all of which are risk factors for heart disease. Other potent triggers are stress, smoking and alcohol.

Heart attack risk in women

It is indeed time for a reality check. One in five Indian women between 15 and 49 years has untreated hypertension. Women generally do not get themselves evaluated unless they are on the other side of their 40s or have had a condition that needs medical attention. Yet cardiovascular disease is the leading cause of death among women globally, surpassing even breast cancer. A 30-year-old woman with diabetes is at a higher risk of a heart attack than a 30-year-old man with the same condition.

While estrogen generally provides some protection against heart disease before menopause, this protection is not absolute, especially in the presence of high-risk factors and behaviour. Still research on heart health is mostly based on studying men, their triggers and their symptoms of a heart attack.

What are symptoms of heart attack in women?

Women may experience unusual fatigue, a sudden exhaustion they never experienced before, even after minor exertion. This they attribute to stress. They may be short of breath with or without chest discomfort. They usually report a dull jaw, neck or back pain that they mistake for a muscle pull or tension.

This is why heart attacks in women are considered silent. That’s why I tell my patients to get a basic heart check-up done whenever they develop a symptom that they have not experienced before. Am not saying they may all turn out to be heart attacks but any new symptom is worth an investigation to be in the clear. Be it unusual abdominal pain, tiredness, a sudden stab of pain or a hot, sweaty flash, if they happen for the first time, do not attribute them to gastric, muscle catch or hormone issues. These could signal a heart emergency.

Why heart attacks in women can take a serious turn

Most heart blocks in men are because of plaque rupture, when the fatty deposit in the artery gets dislodged from the artery wall and blood clots around it to repair the tear.

But in women, it is mostly plaque erosion, where a part of the plaque is damaged causing platelets to clump up and blood to clot. This is the reason that symptoms in women are milder. If left untreated, it can cause a major heart attack. Young women typically have higher levels of estrogen, which can influence the composition of arterial plaques, making them more prone to erosion rather than rupture. Smokers and drinkers are more vulnerable, too.

How to prevent a heart attack through regular check-ups?

Women should get their blood tests done regularly from their 20s to monitor their risk factors. They should get a cardiac evaluation — comprising electrocardiogram (ECG), Echo, stress test, calcium scoring — done in their 30s if they have a family history, or in their 40s without it.

Heart disease among women continues to be under-recognised, underdiagnosed or simply diagnosed late. In women, symptoms are atypical and confusing and are more likely to be missed by doctors. Women should stop taking their heart health for granted and prioritise regular tests alongside lifestyle corrections.

(Dr Shetty is lead cardiologist and medical director at Sparsh Hospital, Bengaluru)