Heart attack signs in women, and why they are missed

Most of us carry a mental image of a heart attack from films: a man clutching his chest and collapsing. For a great many women it does not look like that, and that mismatch is dangerous, because people wait for the dramatic version before taking themselves seriously.

Part of the reason is physical. Women's coronary arteries are smaller, and women more often have disease in the very small vessels rather than a single obvious blockage in a large one. That can mean real, damaging reduced blood flow even when the usual scans look reassuring.

Chest discomfort remains the most common sign in women, so do not dismiss it. But it may be pressure, tightness, squeezing or a heaviness rather than sharp pain, and it may be mild.

Alongside it, or sometimes instead of it, women more often have: breathlessness out of proportion to what you are doing; exhaustion that is sudden and unlike ordinary tiredness; nausea or vomiting; a cold sweat; light-headedness; and pain or discomfort in the jaw, neck, one or both shoulders, an arm, the upper back or between the shoulder blades.

A great many of these are put down to acidity, indigestion, stress or simply being run down. That is precisely the confusion that delays treatment.

During a heart attack, heart muscle is dying, and how much of it survives depends largely on how quickly blood flow is restored. Every half hour of delay means more permanent damage.

Women tend to arrive at hospital later than men do, and a large part of that is not wanting to make a fuss, or being fairly sure it is only acidity. Doctors would far rather see a hundred women with indigestion than miss one heart attack. Being sent home is a good outcome, not an embarrassment.

If these signs come on suddenly, are severe, or are simply not like you, treat it as an emergency. Call for an ambulance straight away rather than waiting to see whether it passes, and do not drive yourself.

Sit down, stay as calm as you can, and unlock the door so help can get in. If you are with someone who has these signs, stay with them and make the call yourself rather than leaving it to them to decide.

This page is to help you recognise an emergency, not to diagnose or treat one. If in doubt at all, make the call.