Women have heart attacks too

Anne Beaton, 75, had a heart attack in 2014

Sarah Brealey speaks to an expert about women's risk of heart disease, particularly as they get older, and meets Anne Beaton, who didn't realise she was having a heart attack.

Anne Beaton, 75, had a heart attack in 2014, but she didn’t know it. “I got a pain in my back, between the shoulder blades,” she says. “It was quite bad but not excruciating. I had no clue it was a heart attack; you hear about people having chest or arm pain.”

Anne, a retired shop assistant and office administrator from Glasgow, was staying with her son and daughter-in-law, who urged her to go to hospital. Anne refused, saying: “I didn’t think it was anything serious. My father died of a heart attack at 49, but it still never occurred to me this is what I was having.”

Over the next couple of days, the pain worsened. “It got to the point where it was excruciating and I couldn’t stand up,” she says. “After three days, I went to the local hospital. They did an ECG and I was rushed to the Golden Jubilee Hospital where I had an angioplasty.

“Because of the delay in getting treatment, my heart has been damaged. I do get tired easily now.”

Low awareness of heart disease

“There is still the notion that women don’t get heart disease,” says Professor Peter Collins.

“Overall, women are more aware of conditions like breast cancer and don’t realise that coronary heart disease can be a bigger risk.”

A heart attack in women can present differently, perhaps as pain in the back

Professor Peter Collins

As Anne experienced, women’s symptoms can differ from ‘classic’ chest pain (this can be true for men, too).

“A heart attack in women can present itself differently,” says Professor Collins, “perhaps as pain in the back between the shoulders. Or a patient may have an episode of nausea and vomiting without chest pain.”

The reasons for this are complex. “In women, a heart attack may be more likely to develop by gradual erosion of the fatty plaque in the coronary arteries, rather than a sudden rupture,” explains Professor Collins. “And it may be that women have a higher pain threshold. We know that oestrogen is an effective anti-pain agent.”

Women may also wait longer to seek help. “Women do come in later than men. Sometimes, they make sure everything is in order before coming to hospital,” says Professor Collins. Our recent survey showed women are more likely to have caring duties.

Anne wants to encourage women to seek help when they need it. “I want other women to know that this could happen to them and they might not realise it is a heart attack,” she says. “I wish I had listened to my family. I would have got help quicker.”

Managing heart disease risk

On average, women are affected by coronary heart disease at a later age than men. “The risk seems to be about 15 years apart,” says Professor Collins. “So a woman aged 70 has the risk of a 55-year-old man, all other things being equal.

Anne Beaton, 75, had a heart attack in 2014“We believe that hormones, such as oestrogen, offer some protection. After the menopause, there is a gradual increase in risk, but not a sharp upturn.”

But, says Professor Collins, “Women shouldn’t be complacent or think this doesn’t affect them. For men and women, your risk increases with age and is increasing exponentially in your 60s and 70s.

“It becomes important after the menopause to identify and manage risk factors. Women often get heavier as they go through the menopause; they may get insulin resistance; LDL (‘bad’) cholesterol will go up and HDL (‘good’) cholesterol will come down. It’s really important to take regular physical activity, monitor blood pressure and cholesterol levels (and manage with medication if need be), and have a healthy diet, including limiting salt and alcohol intake.”

Anne has made lifestyle changes and is keen for other women to avoid the mistakes she has made. “Since the heart attack, I have been eating healthily and I try to take regular exercise,” she says.

Heart attacks: how to spot them and what to do

The symptoms of a heart attack vary. You may feel:

  • tightness
  • heaviness or pain in your chest, arms, neck, jaw, back or stomach. For some people, pain or tightness is severe, while others just feel uncomfortable
  • you may become sweaty, light-headed, dizzy, breathless or nauseous

If you think you’re having a heart attack, phone 999 immediately. Do this even if you’re not totally sure it’s a heart attack. Heart attacks can cause permanent damage to your heart muscle, but swifter treatment allows more muscle to be saved.

Broken heart syndrome

Takotsubo cardiomyopathy known as acute stress cardiomyopathy or broken heart syndrome – causes severe chest pain or breathlessness, similar to the symptoms of a heart attack.

The coronary arteries are not actually blocked, but the left ventricle changes shape. It is quite rare – each year up to 3,000 people in the UK are affected by it.

Around 90 per cent of patients with the syndrome are women. “Takotsubo occurs almost exclusively in women, most of whom are post-menopausal,” says Professor Collins.

“It could be that most men don’t survive it but women do. It is thought to be linked to extreme stress or distress, hence the name ‘broken heart syndrome’. Most patients do get better, although some may have residual left ventricular dysfunction (a cause of heart failure symptoms).”

The BHF is funding research at Imperial College London to help us understand more about this condition.

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