Heart attack signs look different in women

What are the symptoms of heart disease or a heart attack in women?

DENISE

Burbank

Although heart disease is the No. 1 killer of women in the United States, it has been recognized less often by doctors and patients because of a long-held belief that women are protected from heart disease by their hormones.

They are -- up to a point. But after menopause, a woman’s risk of having a heart attack goes up each year, and researchers are finding that for women, many of heart attack’s “classic symptoms,” as defined by men’s experiences, just don’t fit.

Women, in short, experience heart disease and heart attack differently than men. A man experiencing a heart attack will often complain of crushing pressure in his chest and pain radiating down his left arm. Although a woman having a heart attack may describe the same thing, many women instead describe a sharp pain in the chest or mid-back. Often, extreme fatigue -- the result of a buildup of fluid in the lungs -- is a woman’s principal complaint. And swelling in the feet, ankles or legs can be a key sign of impending heart attack for a woman. Breathlessness, dizziness and shortness of breath are indicators of heart attack commonly described by women.

Typically, a woman’s reaction to these symptoms is also different than a man’s. A 2006 study of Irish women found that women took five times longer than men -- an average of 14 hours after symptoms began -- to go to an emergency room in response to complaints that ended up being diagnosed as a heart attack. And U.S. studies have found that women not only take longer to go to a hospital with heart complaints, but they also wait longer to be assessed and treated.

Experts recommend taking preventive action to avoid heart attacks: Don’t smoke, or if you do, stop; get blood pressure and cholesterol checked, and get them treated if they are too high; exercise regularly; and avoid becoming overweight. In addition, women should be attentive to their bodies and what’s normal for them. If their legs seem more puffy than usual, fatigue is nearly overwhelming or if discomfort or pain in the upper body is out of the ordinary, they should seek help.

-- Melissa Healy

I grew up in a steel mill town in Ohio and knew only one person who had asthma. My school years were 1942 to 1954. The air and water were filthy, so I wonder about most of the asthma cases attributed to dirty air. Is there good academic evidence supporting this contention?

DICK HARRIFF

Solana Beach

Since the time you were growing up, the number of asthma cases has increased dramatically. In fact, they have nearly doubled in the last two decades, says Dr. Norman Edelman, a pulmonologist and chief medical officer for the American Lung Assn. That’s not because of increasing air pollution, however. In fact, during that time, air pollution in the U.S. has decreased.

Thus, you are correct in suggesting that the increase in asthma cases is not due to the increase in air pollution. Scientists don’t know the cause, but they do have some theories. For example, they continue to look into the so-called hygiene hypothesis of asthma. This theory proposes that it takes exposure to a certain amount of bacteria to convert the immature immune system present at birth to a mature one that’s less likely to be associated with asthma. Thus, exposure to fewer germs these days may make people more likely to get asthma.

But paradoxically, there is no question that air pollution triggers asthma attacks, Edelman adds. “We know that when there are smog alerts ... asthma attacks increase,” he says. “So there’s a clear relationship between the number of asthma attacks and air pollution.”

-- Janet Cromley

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