Is It a Heart Attack or Heartburn?

You'll know when you're having a heart attack by that telltale elephant-sitting-on-your-chest feeling, right? Probably, but not always.
Women, more so than men, often have something other than that classic crushing or squeezing pain in the chest when they're having a heart attack. Women may feel fatigue, weakness, abdominal or back pain, nausea, or dizziness. Neither they nor their doctor may recognize those as signs of a heart attack.

"Some women go to the emergency room with GI (gastrointestinal) problems, and they are told they have reflux or an ulcer," says Rita Baron-Faust, author of Preventing Heart Disease: What Every Woman Should Know.

"Or, one symptom of a panic attack is fear you're having a heart attack, so there is the assumption that a woman is having a panic attack."
Yet, doctors say the cause of chest pain isn't easy to diagnose.

"Heart attacks can present in such weird ways in general," says Stephen A. Siegel, clinical assistant professor of medicine at New York University School of Medicine, New York, whose medical specialty is cardiology. "I've seen patients who have had pain in their ear.

"Coronary artery disease is a major killer of men and women in the United States. Women tend to think of heart disease as a man's disease because men tend to develop it 10 years earlier than women. However, once a woman reaches menopause, she catches up and even exceeds a man's risk. That's because her estrogen, which protects against heart disease, drops in menopause.

Women's heart attacks more damaging
Women are nearly twice as likely to die from a heart attack as men, according to the American Heart Association (AHA). Women's heart attacks tend to be more damaging and more likely to happen again. Also, women generally don't do as well with bypass surgery as men do.
No one knows exactly why the scales seem to be tipped against women. One theory is that because women develop heart disease at a later age than men, they usually have more health problems, Siegel explains. Their vessels are stiffer. They have had a longer exposure to high cholesterol and a thicker buildup of cholesterol plaque in their coronary arteries. Furthermore, they may never get the typical pains that men often get - the chest pain or pressure, which may radiate into the arm or neck, sometimes accompanied by shortness of breath, sweating or nausea.

When researchers asked about 60 women who had survived heart attacks whether they had known the warning signs beforehand, more than half said that they had not, according to a presentation at a Federation of American Societies for Experimental Biology's annual meeting.
Many studies also show women take one to two hours longer than men to go to the emergency room after symptoms start.

What's worse, Baron-Faust says, is that some patients tend to "self-diagnose" and attribute their discomfort to heartburn or stress and other problems unrelated to cardiac conditions. Unfortunately, their doctors don't always pick up on the true cause. Women also are far less likely to be referred for diagnostic testing that would reveal underlying heart disease.

"Women get treated less aggressively than men," Siegel says. "There's no doubt there's a gender bias, but I think a lot of it is an age bias."

Signs of a heart attack
Whether you're male or female, Siegel says you should know learn the signs of a heart attack and to act fast.

How can you tell if you have heart pain? The classic tightening, squeezing or burning feeling in the chest, called angina, occurs when the heart doesn't get as much blood - and therefore, as much oxygen as it needs. The feeling is almost always associated with physical activity, or exertion.

"If it comes on with exertion and goes away with rest, that's angina. If it comes on with exertion and does not go away with rest, then that's a reason for urgent evaluation. It could be a heart attack," Siegel says.

Some people tend to dismiss angina because it does not feel like sharp, knife-like chest pain. In fact, sharp pains in the chest are unlikely to be a sign of angina. They also may confuse it with indigestion because their pain can be brought on by emotional stress or a heavy meal.
Time is the enemy if you suspect you are having a heart attack. If you have nitroglycerin tablets, take them. Nitroglycerin reduces the pain of angina by widening blood vessels to allow more blood to reach the heart muscle. Aspirin - and it must be aspirin, not ibuprofen or acetaminophen - also works. Aspirin keeps the arteries open by preventing clotting.

Research published in the journal Circulation found that, almost 10,000 more people would survive heart attacks if they would chew one 325-milligram aspirin tablet when they first had chest pain or other signs of a heart attack