The common heart attack symptom many women ignore

The feeling of a heart attack – which occurs when blood flow to the heart is limited or cut off – is often compared to an elephant stomping on your chest. But the signs can sometimes be far subtler, particularly in women. In fact, one of the most common symptoms in this group is something you might be tempted to push through or ignore: fatigue.

To be sure, exhaustion with a clear cause, such as feeling tired after a long week of work or a few nights of bad sleep, is not something to worry about, says Arash Bereliani, a cardiologist at Beverly Hills Institute for Cardiology and Preventive Medicine. But “a significant, unexplained decrease [in energy] from your baseline” warrants concern, he says.

Research suggests women are more likely than men to experience a range of warning signs in the days and even weeks leading up to a heart attack, with the most common being fatigue, occurring in up to 70 per cent of women who have a heart attack.

The reason the two go hand in hand: a drop in blood flow to the heart causes it to “become stiff and not work properly,” Bereliani explains. Over time, it struggles to pump out enough blood, so your other organs and muscles begin to miss out on critical oxygen and nutrients, leading to low energy.

But feeling exhausted, even to an extreme, doesn’t always set off alarm bells – for women or doctors. After all, “so many women are multitaskers and are time-starved and are caregivers and are working and have so many things on their plate,” says Amy Ahnert, a cardiologist with Atlantic Medical Group and director of the Women’s Heart Program at Morristown Medical Centre.

In a large study of people under age 55 hospitalised for a heart attack, women were more likely than men to perceive their symptoms as simply stress or anxiety, and also to have seen a provider who did not attribute their symptoms to their heart.

Below, experts explain why severe fatigue often accompanies a heart attack in women and how to tell if your exhaustion is a red flag.

The majority of research done on heart attacks has been conducted in men, “and for many years, we deduced that their typical symptoms – chest pain and tightness with radiation down the left arm – would extend to women,” Bereliani says. While it’s since become clear that women often experience other symptoms, science hasn’t quite caught up to explain why.

One theory is related to differences in heart size and anatomy, Bereliani says. A heart attack might activate the nervous system in distinct ways or cause more pronounced changes in blood flow to different organs in men versus women, leading to varying symptoms.

The most common cause of a heart attack, a buildup of plaque inside an artery, also tends accompany a rise in inflammation, Bereliani says. This seems to be more commonly linked with fatigue in women than it is in men (for reasons experts don’t fully understand).

There are also distinctions in the kind of heart disease that tends to strike men versus women.