woman's hands holding red toy heart
Spotting heart attack signs early could save a life.

It’s a known fact that heart disease and stroke combined is the leading cause of death among women in Singapore. And the most common manifestation of a heart attack – which signals that a part of your heart is dying – in women, is chest tightness associated with cold sweatiness, nausea, dizziness, says Assoc Prof Tan Huay Cheem, Chairperson of the Cardiac Rehabilitation/Heart Wellness Centre Committee, Singapore Heart Foundation. While these are obvious symptoms, there are warning signs that can be subtle. Heart attack signs are not always sudden or severe, and about one quarter of people say they didn’t experience chest pain at all. “One of the major reasons for the variability in patients with a heart attack is that the heart muscle doesn’t receive the same kind of nerve supply as the skin, skeletal muscles and bones. The heart has no pain fibres,” says Dr Tong Khim Leng, chief of the Department of Cardiology, Changi General Hospital. The good news is, people who are treated within an hour of their first heart attack have the greatest chance of surviving and continuing to enjoy a good quality of life. Paying attention to the more discreet signs could save your life:

Subtle Sign: Toothache
Although most of us would expect pain, or pressure, in the chest to be the predominant sign of heart disease, in fact, the pain can refer to other parts of the body, including the teeth and jaw. It is not uncommon for angina or heartrelated pain to be experienced as discomfort in the lower jaw and patients will often say that they feel as though they have a toothache radiating on both sides. In fact, this symptom is quite specific for heart pain and will often raise suspicion with the cardiologist.

Subtle Sign: Excessive Sweating
Not everyone who breaks into a sweat has a dodgy ticker, but excessive, “clammy or cold swats, heart flutters, or palenss can all be signs of heart attack,” says Prof Robert Graham, executive director of Sydney-based Victor Chang Cardiac Research Institute. Shortness of breath is another sign. “Each woman will present with different symptoms of a heart attack,” says Graham. “Some experience several symptoms while others show all symptoms. There are women who show no symptoms before their heart attack. The sooner you can recognise your symptoms and take appropriate action, the better.”

Subtle Sign: Tummy Troubles
Many women suffering heart attack believe that they may have a tummy bug. “About a third of elderly women having a heart attack present with abdominal pain, nausea and vomiting,” says Dr Tong. In the absence of chest pain, patients will frequently interpret mild nausea or vomiting and sweating as being due to another problem such as a viral illness, rather than due to an underlying heart issue. It’s common for central chest or upper abdominal discomfort to be interpreted as heartburn or indigestion.

Subtle Sign: Neck, Shoulder Or Back Pain
Discomfort in the shoulder blades, shoulder or neck can be signs of an underlying heart problem. But it can often be interpreted as muscle ache or back strain. In fact, most women will pass off this type of pain as the result of overexertion at the gym or sitting too long at a desk.

Subtle Sign: Dizzy Or Vacant Spells
Not feeling “quite with it”, dizzy spells or feeling lightheaded can be a sign of a problem with your heart. “Unexplained feelings of anxiety, fatigue or weakness – especially with exertion – are other signs,” says Prof Graham. Others report a feeling of “impending doom”. “Women often ignore these early warning signs,” adds Prof Graham. “This is for a few reasons – one is that pain tolerance is often better in women than men and also women often ascribe their symptoms to other things, particularly if they are very busy looking after the household and children.”

Subtle Sign: Fatigue And Weakness
If you feel completely washed out for no reason, your heart could be under strain. Fatigue that is new and unexplained is a sign of heart attack. Sudden, profound weakness (muscle weakness all over the body or just in one area) is another. If fatigue stops you from going about your daily routine, it’s worth getting a heart check-up.

Anyone with a suspected heart attack should call 995 for help, advises Assoc Prof Tan. “One of the causes of sudden death in patients with a heart attack is the occurrence of a dangerous heart rhythm, called ventricular fibrillation (VF). This is a situation where the heart literally stops contracting and the patient has six to 10 minutes for revival, before the brain suffers irreversible damage.” The most effective treatment for VF is defibrillation, which is delivering an electric current through the heart with a defibrillator, which is available in all SCDF ambulances. At the same time, the ambulance medic is able to perform electrocardiogram (ECG) recording which can be faxed to the nearest hospital. When confirmed to be a heart attack, the hospital cardiac team would have been activated even before the patient arrives. That will help to shorten the treatment of care, which is now emergency coronary balloon angioplasty and stenting. “Unfortunately, only 35 per cent of sufferers go to hospital by ambulance. The rest still make their own way to a hospital which can pose a tremendous risk,” says Assoc Prof Tan.

Related: More heart attack signs you must know
Related: Exercises to keep your heart healthy

Text: Bauer/Good Health
Photo: 123RF