Fatigue Often Precedes Heart Attacks in Women

Most women who have a heart attack have experienced telltale symptoms, such as extreme fatigue and sleep disturbance, during the weeks leading up to the attack, investigators report.

Chest pain, however, is not usually one of these symptoms.

According to their report the American Heart Association's journal Circulation, Dr. Jean C. McSweeney and her colleagues believe that doctors sometimes don't recognize that a woman is having a heart attack because the symptoms don't match those of men, who more commonly experience severe chest pain.

To further investigate, McSweeney, with the University of Arkansas for Medical Sciences, Little Rock, and colleagues telephoned 515 women who had had a heart attack within the previous 4 to 6 months. The women were asked what symptoms they experienced before and during the heart attack.

Ninety-five percent of the subjects reported unusual symptoms during the weeks leading up to the heart attack.

"These are symptoms that change in intensity or frequency, or they're a brand new appearance, starting in the period prior to their heart attack," McSweeney told.
The most frequently reported were unusual fatigue (71 percent) and sleep disturbance (48 percent). Shortness of breath, indigestion and anxiety were also common. Less than a third reported chest discomfort, and when they did it was most often described as pressure, aching or tightness.

"A lot of women ignore these symptoms, thinking it's just because they're 'getting older,"' McSweeney commented. "But even when they do go to a physician, their physicians may overlook these symptoms."

These warning signs can be overwhelming, she said, and shouldn't be shrugged off. Some of the subjects said they had been so tired they couldn't finish making a bed without having to rest. Others said they had trouble climbing stairs.
"Women need to explain to their doctor how these symptoms are impacting their daily life. They should specifically say what they can't do, so that physicians can judge how severe this fatigue is."

When the heart attack occurred, the acute symptoms most commonly reported were shortness of breath, weakness, unusual fatigue, cold sweat and dizziness. If they had chest discomfort, they rarely described is as "pain."

Most women also had conventional risk factors, such as a history of cardiovascular disease, diabetes and high blood pressure.

"I'm trying to get women and physicians to look not only at these symptoms but also at their cardiovascular risk factors, such as hypertension or a strong family history of heart disease," to decide what diagnostic tests should be performed, McSweeney concluded.