For Laura Bedrossian, it came on when she was running. After a four-miler in 2013, she couldn’t catch her breath and her chest hurt. A heart attack didn’t cross her mind; after all, she was 28 at the time and fit.
But the next morning, she was still short of breath and had trouble going down subway stairs to get to her job as a communications/PR consultant. That’s when she started to get worried. She told two co-workers who suggested she get medical attention. “I was more concerned when things didn't go away the next morning, which led to nervousness and heightened symptoms,” says Laura, now 30. “Then with co-workers being concerned, that upped the anxiety and that's when I thought I had maybe had a heart attack and didn't know it.”
It’s reasonable to be worried in such a situation, says Nieca Goldberg, M.D., medical director of the Joan H. Tisch Center for Women’s Health at NYU Langone. You shouldn’t ignore symptoms like this, but their timing and severity will determine whether you need to call 911 immediately or make an appointment with your doctor to figure out what’s going on.
If you wake up in the middle of the night with crushing chest pain, shortness of breath, or pain in one or both arms, that could indeed be a heart attack and you need to go to the ER, she says. Heart attacks don’t automatically make your heart stop, but they can; that’s why you need a doctor to help get blood flowing again. And it’s not completely unheard of in younger women: More than 30,000 heart attacks occur every year in women under 50. While that’s just a fraction of the 735,000 Americans yearly who have a heart attack, it’s higher than you’d think.
But a heart attack can happen at any time, not just during sleep, says Goldberg, who’s also a clinical associate professor of cardiology at the NYU School of Medicine and a national spokesperson for the American Heart Association. And in addition to the most common symptom of chest tightness (which some say feels like an elephant sitting on their rib cage), other warning signs, which come on suddenly, include feeling nauseous, breaking out in a cold sweat, or pressure going down your arm or up your neck on either side. Dr. Goldberg says some people mistakenly ignore pain on their right side because they know their heart is on their left; it doesn’t matter. But the symptoms can also be more subtle in women. Instead of having pressure in their chest, they might feel exhaustion unlike any before and be unable to take a full breath. If you experience these symptoms, you need to get to a hospital.
What if that’s not exactly what’s happening to you? There are other things that cause chest pain that still need to be treated, just not quite as urgently, Dr. Goldberg says. For one, some people confuse panic attacks for heart attacks and vice versa. With a panic attack, people generally experience a stressful trigger and then start hyperventilating — that is, breathing very quickly and shallowly. It’s different from feeling short of breath, she says.
In people with exercise asthma, the chest pain is accompanied by a dry cough and wheezing, which is a whistling noise when you breathe. (If you know you have asthma and your rescue inhaler isn’t helping an acute attack, you should go to the ER in that case as well.)
Then there’s acid reflux, which can cause discomfort in the upper abdomen, but that’s more of a burning feeling accompanied by an acidic taste in your mouth. With all of these conditions, it’s important to figure out what’s happening so you can learn how to prevent it, she says.
Certain women should be on higher alert for heart attacks because their risk is greater. Some of it is hereditary, but lifestyle factors can make things worse. For instance, your risk goes up if your mom had a heart attack before 65 or your dad had one by 60, or if you smoke, have diabetes, or have high cholesterol.
“If you know that you have risk factors you should check out your other risk factors and act on them — and certainly women should quit smoking,” Dr. Goldberg says. Smoking can triple your risk of having a heart attack: It’s been shown to lower good HDL cholesterol and can cause spasms of the arteries, which block blood flow and can lead to a heart attack.
Being on alert also means paying attention to possible warning signs. For instance, some people notice a decrease in endurance and have chest pain or shortness of breath while working out. Dr. Goldberg says some women who’ve had heart attacks had symptoms like this six to eight weeks beforehand and ignored them. “People subconsciously reduce their exercise intensity to prevent the symptoms,” she says. “But if you notice it and it’s new, that’s the time to see your doctor because then you can be evaluated and probably avoid an ER visit.” Which, for the record, isn’t cheap.
At the end of the day, if you’re having recurrent chest pain, you should talk to a doctor about it. “We don’t want people to ignore symptoms,” says Dr. Goldberg. “No matter whether it’s a heart attack or a panic attack, we want people to feel better.”
As for Laura, she called her primary doctor and was seen right away. Her doctor did an EKG and determined she wasn’t having a heart attack (phew). She told Laura it was likely exercise-induced asthma and she should call back if she had any more breathing problems and wanted to discuss a preventive inhaler. Luckily for Laura, she’s felt “completely fine” during workouts since that day — but if it ever happened again, at least she’d know what to do.