In the wake of Carrie Fisher’s death four days after she suffered a massive heart attack, one thing that was reported by some news outlets was that she had been in “significant distress” on the flight. We don’t know the exact details of this, but in my experience as an EMT, it often means “hysterical woman having a panic attack and thinking she’s dying…*woman dies* …oops, guess she really was dying.”
It is SO IMPORTANT to remember that many women present in what medicine considers an ‘atypical’ manner for heart attack, but it actually IS typical…for women. Women are more than twice as likely to die from cardiac emergencies, not because our physiology is that much different than men and thus gives us a worse chance at survival (it’s actually better if treated promptly and adequately), but because our symptoms are more likely to go unrecognized or to be dismissed entirely.
Thus, please take a moment to review and pass on this list of cardiac distress symptoms as seen in women:
Shortness of breath - This is the most common one. If a woman, especially one without prior history of respiratory issues or shortness of breath, seems to be having trouble catching her breath and/or complains of such, pay very close attention. If she continues to feel winded after sitting or laying down, it’s probably time to call for help.
Feeling of impending doom - This can range from a sense of general unease to a full-blown panic attack. This one is extremely important, and is the symptom most commonly disregarded by doctors and hospital staff. If a woman tells you that she feels ‘not quite right,’ or like something terrible is about to happen, or that she’s about to die, LISTEN TO HER FFS.
Nausea and “indigestion” - Also common. Heart attacks frequently present as a feeling of vague nausea or indigestion, but unlike typical heartburn, antacids and other OTC treatments will not alleviate the symptoms.
Hiccups - Unexplained hiccups, especially if seen with any of the other symptoms listed above, can be indicative of heart muscle that is being acutely or chronically starved of oxygen. The exact mechanism isn’t known, but it’s thought that the enzymes released by the dying muscle irritate the pericardium and adjacent diaphragm, causing spasms in the healthy muscle.
Fatigue - This is another commonly seen symptom, and is often overlooked or ignored as just transient tiredness. Many women having a heart attack will complain of feeling “flu-like” symptoms of nausea, sweating, fatigue, and shortness of breath, and they’ll lie down for a nap and never wake up.
Lightheadedness - A feeling of being lightheaded or about to faint isn’t terribly uncommon in many benign conditions, and many women experience it on a monthly basis. However - be aware when it appears unexpectedly or unexplainedly, and/or with one or more of the other symptoms on this list.
Sweating (diaphoresis) - Heart attack does funny things to the sympathetic nervous system, which is behind reflexes such as sweating and hiccups. If a lady is experiencing unexplained or excessive sweating, pay attention to anything else that might be going on with her.
Tingling or numb extremities - A feeling of numbness or “pins and needles” tingling in the extremities can be an important sign that cardiac function is being impaired and those body parts aren’t receiving enough oxygen.
Peripheral and/or central cyanosis - Often accompanies tingling or numbness, and is considered a later-stage symptom of cardiac distress and heart failure. Finger and toe tips will turn pale or blue first, and lips and gums after that. Important to remember that darker-skinned women may present cyanosis as ashen, grey, or darker purple rather than pale or blue.
Back pain - Pain between the shoulder blades, in the cervical spine, or even further down in the torso or lumbar region can be a symptom of heart attack. Alone, it isn’t that suspicious, but if it’s unrelenting and presents with any of the other symptoms above, keep a watchful eye on things.
Classic “crushing” or “tight” chest pain or pressure - Women DO experience this classic pain, too, just not as frequently as men do. This may be due to our higher pain threshold, or differences in blood volume, or maybe we’re just not sure because nobody’s bothered to really study it. Whatever the reason, some women do still experience the crushing or tightening pain, and others may experience less painful pressure or tightness that doesn’t seem to be relieved by anything.
Arm and jaw pain - Another “classic” heart attack symptom, and a bit more common than central chest pain. Unexplained pain in the left arm or shoulder, and on the left side of the neck or jaw, should not be ignored by anyone.
March 1, 2017 >> A little early morning early morning studying of my favorite body system for my patho test later today ft. breakfast smoothie. Pro-Tip: there’s spinach in that smoothie adding all kinds of nutrients and you can’t even see or taste it 👍🏼
So about 2 months ago this happened. It was scary to be experiencing something that I normally treat at work. I had just walked into the gym and had only started stretching when I had a feeling in my chest of my heart skipping a beat. After a moment I realized my heart was racing so I stepped outside to try and figure out what was going on. I had a hard time feeling my pulse but when I placed my hand on my chest I could tell something wasn’t right…..my heart was racing!! I tried vagal maneuvers without any luck. I walked back into the gym and grabbed my boyfriend and told him WE HAVE GOT TO GET TO THE ER. Luckily for me, there was one across the road. He dropped me off at the door so I could go in while he parked. At this point my ears and ringing, I’m feeling extremely light headed and I know I’m about to pass out. I tell the tech at the front desk “ I’m a paramedic and I think I’m in SVT.” I got a strange look and she quickly grabbed a nurse. I explained to the nurse who took me back and placed me on the 12-lead. This was my EKG when I walked in. My heart rate was in the 260’s, my ears were ringing and I was about to pass out. I was quickly taken back to a room and placed on a cardiac monitor and had an IV started. A physician came in and started to explain what was going to happen. I told him I completely understood, just to please fix me. 6mg of adenosine later and I was back to a heart rate of 100 and finally had a blood pressure.
I was taken out of work and had an ablation 3 weeks after the episode. I am 27 years old, healthy and mostly fit. I have no medical problems and definitely no cardiac issues. This was the first time this has ever happened. Quite possibly one of the scariest days I have had.
To an EMS provider this can seem like no big deal but when you are the patient in the moment, it seems like you are about to die. Granted, most people don’t go into SVT at a rate of 260. I’m finally back to work and feeling great. I still get a little paranoid it will happen again but there is a 95% success rate with ablations. It’s always strange to be the patient and not the provider but this was an eye opening experience for me. Now I can actually tell my patients why they will be feeling with that nice push of adenosine.
The term “heart failure” makes it sound like the heart is no longer working at all and there’s nothing that can be done. Actually, heart failure means that the heart isn’t pumping as well as it should be. Congestive heart failure is a type of heart failure which requires seeking timely medical attention, although sometimes the two terms are used interchangeably. Your body depends on the heart’s pumping action to deliver oxygen- and nutrient-rich blood to the body’s cells. When the cells are nourished properly, the body can function normally. With heart failure, the weakened heart can’t supply the cells with enough blood. This results in fatigue and shortness of breath and some people have coughing. Everyday activities such as walking, climbing stairs or carrying groceries can become very difficult.
A patient yesterday asked me to lift his head up and then put it back down. And then yelled at me when I did it because I lifted too high. Then later asked me to fluff his pillow nicer than it was. And yelled at me for lifting his head up to fluff said pillow. And tried to demand to talk to the ICU doc about it all.
This wasn’t even my patient. His nurse was so done lol.
Cardiac defibrillator used during an open heart surgery in an event of cardiac dysrhythmia in order to save the patient’s life. The internal paddles for defibrillation are shown positioned on the anterior and posterior aspects of the heart.