Women Over 45: When a Heart Attack Doesn’t Look Like One

This is not a wellness roadmap. Your own clinician is the right place for
screening and prevention.

What an emergency room knows is one specific, consequential thing: a woman's
heart attack frequently does not look like the picture everybody was taught —
and the symptoms it produces instead are the ones most readily explained away as
stress, anxiety, indigestion or being run down.

That is the article. Everything else here is secondary to it.

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What it can look like instead

Chest pain may be mild, may be described as pressure or tightness rather than
pain, or may be absent altogether. What may be more prominent:

• Unusual, profound fatigue — not ordinary tiredness. Tired in a way that is
  new and disproportionate, sometimes for days beforehand.
• Shortness of breath, with or without any chest discomfort
• Pain or discomfort in the jaw, neck, shoulders, upper back or arms
• Nausea, vomiting, or indigestion that feels wrong
• A cold sweat, clamminess
• Light-headedness or feeling you might faint
• A sense that something is seriously wrong without being able to say what

Any of those, new and unexplained, is a reason to be assessed — and if
several arrive together, call 911.

The two that are most often dismissed are the profound fatigue and the
nausea, because both have a hundred ordinary explanations and because they
arrive without the one symptom everyone is watching for.

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Saying it so it gets heard

This section exists because symptoms like these are attributed to stress and
anxiety — by clinicians, and by the women experiencing them. Self-doubt is the
first obstacle and it is usually the biggest.

What helps, practically:

• Say the word heart. "I am worried this might be my heart" changes a
  conversation in a way that "I have been feeling off" does not. It is not
  rude and it is not dramatic — it tells us which question you want answered.
• Lead with what is new. Not how bad it is. "This is different from
  anything I have had before" is the most useful sentence you can say, because
  novelty is the signal clinicians act on.
• Say if you have been dismissed before. It is relevant information, not a
  complaint.
• Bring someone if you can. Not because you cannot speak for yourself, but
  because a second person remembers what was said.
• Ask directly: "have we ruled out my heart?" It is a fair question and a
  reasonable one to want answered before you go home.

You do not need to justify coming in. "I thought it was just stress" is a
sentence heard far too often afterwards.
Chest pain ·
Panic, anxiety and when it belongs here

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Three others worth knowing about

Heavy or prolonged bleeding around menopause can cause severe anaemia, and it
often presents as breathlessness, exhaustion, dizziness or fainting rather than
as a bleeding problem. If you are soaking through protection hourly, passing
large clots, or feeling faint, be seen. It is also worth investigating rather
than enduring — heavy bleeding at this age needs a cause, not just management.

Bones become more fragile after menopause, which means a fall from standing
height can break something, and a wrist, hip or spine fracture can happen with
force that would not have mattered at 35. If you have fallen and something
hurts, get it imaged.
Falls ·
Sprain, strain or break

Sudden severe abdominal or pelvic pain always deserves assessment — there are
several causes specific to this age group and none of them is improved by
waiting.
Abdominal pain

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What happens when you arrive here

• A physician sees you — board-certified, every visit, at every hour.
• An ECG and blood tests, which are what answer the cardiac question, run in
  our own laboratory so results come back during the visit.
• CT and X-ray on site. Ultrasound is called in from a mobile service.
• A critical care room here for the presentations that need one.
• Monitoring for up to 24 hours, which matters because a first set of blood
  tests can be normal and a second set hours later can not be.

If you need admission, a cardiologist or a specialist, we stabilise you and
arrange the transfer. We are an emergency room, not a hospital.

That monitoring point is worth understanding before you arrive: if you are
asked to stay and be re-tested, that is the test working rather than nothing
being found. People go home between the two, and that is the gap this article
is trying to close.

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El Mirage ER — open 24 hours a day, 7 days a week, 365 days a year.
12000 N El Mirage Rd, El Mirage, AZ 85335 · (480) 237-4922
Walk in. No appointment, no referral.
If this is a medical emergency, call 911.

This article explains when to seek emergency care. It is not medical advice and
cannot account for your history or medications. If you are unsure, call us or
call 911.

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Sources

The guidance in this article about when to seek emergency care is drawn
from these public sources. Each one is linked so you can read it yourself.

• MedlinePlus (National Library of Medicine) — Women's Health — https://medlineplus.gov/womenshealth.html

This article is general information, not a diagnosis, and it cannot account
for your history or medications. If you are unsure, call us on (480) 237-4922
or come in. If it might be an emergency, treat it as one and call 911.

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