Women and men are different, including in the way we present with heart attacks. Most of the classic symptoms of crushing chest discomfort, sweating, and shortness of breath with arm aching (which normally provoke an urgent response when present) may be completely absent in the woman having a heart attack.
Women are more likely to go undiagnosed and die with their heart attack because it goes unrecognized.
The more typical complaints have more in common with anxiety or panic attacks or just not feeling right. They are all too easily dismissed as not life threatening. If you have these symptoms and don’t know you are free of arterial disease, you should ask yourself or the doctor you are seeing: “Could I be having a heart attack?”
That is why I believe it is even more important for asymptomatic women than men to be screened for arterial disease with carotid ultrasound looking for plaque. These symptoms in a woman with known disease will be taken more seriously, while reassurance will be easier and more appropriate if screening reveals no disease.
I have commonly had couples present to my office to have the male screened for arterial disease. When we turn to the woman and convince them early detection and prevention are important for both, we often find more severe disease in the woman.
It costs so little and is painless to be screened with carotid ultrasound with intima media thickness and plaque character focus. It will detect disease far earlier than stress tests or even angiograms at a fraction of the cost and risk.