Heart attack and women

A heart attack happens when blood flow in an artery to the heart is blocked by a blood clot or plaque, and the heart muscle begins to die. Women are more likely than men to die after a heart attack. But if you get help quickly, treatment can save your life and prevent permanent damage to your heart.

What is a heart attack?

A heart attack happens when blood flow to your heart muscle is blocked and the cells in your heart muscle begin to die. Many different health problems can cause a heart attack, but coronary artery disease is the most common.

What are the symptoms of a heart attack in women?

The most common symptoms of a heart attack for both women and men are pain and discomfort in the chest and upper body. Other symptoms, like shortness of breath and nausea, are more common in women than men. Learn more about heart attack symptoms in women.

What is the difference between a heart attack and cardiac arrest?

A heart attack is not the same as cardiac arrest. In a heart attack, the heart keeps beating. The person has a pulse and usually stays conscious (awake). During cardiac arrest, the heart stops beating. The person has no pulse and is unconscious (not awake).

A defibrillator (dee-FIB-ruh-lay-tur) is a machine that sends an electrical shock to the heart to restore normal rhythm. This treatment must be given as soon as possible. For cardiac arrest, call 911 and begin CPR (cardiopulmonary resuscitation) right away. The American Heart Association says that with "hands only" CPR, anyone can give lifesaving treatment to someone having cardiac arrest. Push hard and fast in the center of the chest and keep going until emergency personnel arrive. Do not give CPR for a heart attack.

What causes a heart attack?

Coronary artery disease (CAD) causes most heart attacks. In people with CAD, plaque builds up on the walls of the arteries that supply blood to the heart. This is called atherosclerosis (ath-UH-roh-skluh-ROH-sis).

Plaque can build up in fatty clumps or in a thin, smooth layer. Both types are dangerous. The plaque can break open or wear down, causing blood to clump together (clot) in that area. If a clot blocks blood flow to the heart, it can cause a heart attack.

This picture shows how CAD causes a heart attack. Plaque builds up in an artery of the heart, and a blood clot forms. The clot blocks blood flow to part of the heart, and the heart muscle begins to die.

A heart attack can also happen if the artery pinches itself closed. This is called a coronary spasm. Coronary spasms are rare. They happen more often in young women than in older women or men.

Learn more about CAD.

How do I know if I am at risk for a heart attack?

A heart attack can happen to anyone, woman or man, young or old. Some people are more at risk because of certain health problems, family health history, age, and habits. These are called risk factors.

You can't change some risk factors, like your age, race or ethnicity, or family history. The good news is that you can change or control many risk factors, such as high blood pressure, diabetes, smoking, and unhealthy eating.

Learn more about controllable and uncontrollable risk factors for heart disease.

Do women of color need to worry about heart attack risk?

Yes. All women need to be aware of their heart attack risk and take steps to prevent heart disease.

African-American, Hispanic, and American Indian or Alaska Native women often have more heart attack risk factors than white women.^1,2 These risk factors can include obesity, lack of physical activity, high blood pressure, and diabetes.

African-American women are also more likely to have a heart attack and more likely to die from a heart attack compared with white women.³

Do women do worse than men after a heart attack?

Yes. In all age groups, women do worse than men after a heart attack. Researchers are not sure why this is, especially for younger women.

• Women between 45 and 65 who have a heart attack are more likely than men of the same age to die within a year of a heart attack.⁴ However, heart attack is less common in younger women than in younger men. This is partly because the hormone estrogen protects against heart disease in younger women.
• Women older than 65 are more likely than men of the same age to die within a few weeks of a heart attack.⁴ Women usually have heart attacks about 10 years later than men. The average age of a first heart attack for men is 64, but it is 72 for women.

Many women who have had a heart attack go on to lead full, active lives. Know the symptoms of a heart attack and what to do if you have any symptoms. Take steps to recover after a heart attack and prevent another heart attack.

How is a heart attack diagnosed?

To diagnose a heart attack, a doctor will ask you about your symptoms, your health, and your family health history. The doctor will also order tests.

Doctors often use these types of tests to diagnose a heart attack and choose the best treatment.

• Blood tests. During a heart attack, heart muscle cells die and burst open. This process releases proteins into your blood. Heart attack blood tests measure the amount of these protein "markers" of heart damage. Common heart attack blood tests include:
  • Cardiac troponin [TROH-puh-nin]. This is the most common blood test. This marker is released from the injured heart muscle. It is not found in the blood of healthy people. Troponin levels go up three to six hours after your heart attack starts, so the test may not find a heart attack right away.
  • Creatine Kinase-MB (CKMB). The CKMB test measures the amount of damage to the heart because of blocked blood flow. The test can tell whether treatments to restore blood flow to the heart are working. CKMB levels rise about four to six hours after a heart attack starts and peak 24 hours later.
  • Myoglobin. This test helps diagnose a heart attack in the very early stages. After a heart attack, myoglobin levels rise within one to four hours but peak after 12 hours.
• Coronary angiography (an-jee-OG-ra-fee), or angiogram. This test takes pictures of a dye flowing through your blood vessels. By watching how smoothly the dye flows, doctors can locate narrowed or blocked coronary arteries that might need to be opened, or find other problems.

Women are more likely than men to have a less-common type of plaque that forms a smooth layer over the arteries instead of a few big lumps. Often, angiograms can't see this thin, smooth plaque, but this type of plaque is still very dangerous. Other tests (such as those described above) might be needed for women who show signs or have symptoms of a heart attack but whose coronary angiography results do not show any problems.

• Nuclear heart scan. This test takes pictures to show areas of the heart that may be damaged because they are not getting enough blood. It can also show how well the heart is pumping. Tell your doctor if you are pregnant or breastfeeding. The test uses radioactive material that can harm your baby.
• Electrocardiogram (ECG or EKG). This test detects and records your heart's electrical activity. Certain changes in the electrical waves on an ECG can show whether you are having, or have had, a heart attack. An ECG can also be done during physical activity to monitor your heart when it is working hard.

How is a heart attack treated?

Heart attack is most often treated with medicine or nonsurgical procedures that break up blood clots and restore normal blood flow to the heart. Some treatments will start right away, when the ambulance comes. You will get other treatments later, in the hospital.

Getting treatment right away for a heart attack can help prevent or limit damage to your heart muscle. This is one reason why it is important to call 911 if you think you are having a heart attack, rather than driving yourself to the hospital.

What medicines treat a heart attack?

Medicines you might receive if you have a heart attack include:

• Clot busters. These drugs are also called thrombolytics (throm-buh-LIT-iks). They stop a heart attack by breaking up blood clots to open blocked arteries. To work best, these medicines must be given as soon as possible after the start of heart attack symptoms. You might get them in the ambulance or in the hospital. If you get them soon after having a heart attack, you're more likely to survive, and your heart is more likely to recover.
• Aspirin and blood thinners. These medicines stop blood cells from clumping together and forming new clots. If you call 911 for a heart attack, the operator might tell you to chew up and swallow an aspirin while you wait for the ambulance. It can help reduce damage to your heart and your risk of dying by 25%.⁵ Once you arrive at the hospital, you might get a different blood thinner called an anticoagulant through an intravenous line (IV) that carries the medicine right into your bloodstream.
• Nitrates. Nitrates widen your arteries and increase blood flow to your heart. Once you arrive in the hospital, you may be treated with nitrates through an IV. One common nitrate is called nitroglycerin (nahy-truh-GLIS-er-in).
• Beta blockers. Beta blockers lower your heart's workload. These medicines help relieve chest pain and discomfort and prevent repeat heart attacks. Beta blockers may also be used to treat arrhythmias (irregular heartbeats), which often happen during a heart attack.
• ACE inhibitors. ACE (angiotensin-converting enzyme) inhibitors lower blood pressure and strain on your heart. They also help slow down weakening of the heart muscle.

You may also be given other medicines to relieve pain or anxiety or lower your cholesterol.

What procedures treat a heart attack?

The most common procedures to treat a heart attack include:

• Angioplasty and stenting. Angioplasty, also called percutaneous coronary intervention, is a nonsurgical procedure that opens blocked or narrowed coronary arteries. A thin, flexible tube with a medical balloon on the end is threaded through a blood vessel to the narrowed or blocked coronary artery. Once in place, the balloon is inflated to open the artery to allow blood flow to the heart. The balloon is then deflated and removed. A small mesh tube called a stent may be permanently placed in the artery. The stent helps prevent new blockages in the artery.
• Coronary artery bypass grafting. The surgeon uses a healthy blood vessel from another part of your body to re-route blood around the blockage in your artery. You may need this surgery if more than one artery is blocked, or if angioplasty and stenting did not work to restore blood flow to the heart.

After a heart attack, you may also need cardiac rehabilitation to recover from the damage the heart attack did to your heart.

How can I prevent a heart attack?

All women can make changes to help prevent a heart attack. These changes include making healthier food choices, being more physically active, and not smoking. Once you know your heart attack risk factors, you and your doctor can work together to lower your risk.

Even if you had a heart attack before, you can make changes to help prevent another heart attack. Learn more steps to prevent heart attack and heart disease.

Did we answer your question about heart attack?

For more information about heart attack, call the OWH Helpline at 1-800-994-9662 or check out the following resources from other organizations:

• Heart Attack — Information from the National Heart, Lung, and Blood Institute
• Heart Attack — Information from the Centers for Disease Control and Prevention

Sources

1. Giardina, E-G., Sciacca, R., Foody, J., D'Onofrio, G., Villablanca, A.C., Leatherwood, S., Taylor, A.L., …Haynes, S.G. (2011). The HHS Office on Women's Health initiative to improve women's heart health: focus on knowledge and awareness among women with cardiometabolic risk factors. Journal of Women's Health, 20(6), 893–900.
2. CDC. (2017). Summary Health Statistics: National Health Interview Survey: 2015.
3. Safford, M.M., Brown, T.M., Muntner, P.M., Durant, R.W., Glasser, S.G., Halanych, J.H., … Howard, G. (2012). Association of race and sex with risk of incident acute coronary heart disease events. Journal of the American Medical Association, 308(17), 1768–1774.
4. Mozzafarian, D., Benjamin, E.J., Go, A.S., et al. (2016). Heart disease and stroke statistics—2016 update: a report from the American Heart Association. Circulation;133:e38-e360.
5. Antithrombotic Trialists' Collaboration. (2002). Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ, 324, 71–86, cited in Circulation article, 2012.

This content is provided by the Office on Women's Health.