For three days Doña Rosa kept saying she felt "like I'm coming down with something." The stairs up to her apartment wore her out, there was a dull unease right under her breastbone that she blamed on Sunday's tamales, and at night a nagging ache between her shoulder blades kept her from getting comfortable. Nobody at home thought about her heart, because nobody clutched their chest or collapsed the way people do on TV.
That scene plays out more often than most of us would guess. The picture of a heart attack we carry around comes from the way it frequently shows up in men: a crushing grip in the middle of the chest that spreads down the left arm. Women can have that too, but just as often the warning arrives in disguise, and so many of them wait, treat themselves at home or go to bed hoping it will be gone by morning.
This article is for you, your mom, your sister or your mother-in-law. The goal isn't to frighten anyone. It's to help you read the signs early on the day something feels off.
First things first: if it's happening now, call 911
Before you read any further, hold on to this. If you or someone next to you has chest pain or pressure lasting more than a few minutes, sudden shortness of breath, a cold sweat, fainting, or a sudden mix of the symptoms listed below, call 911. Don't drive yourself to the hospital, don't ask someone to take you by car and don't head to the clinic: paramedics start treating you the moment they reach your door, and they alert the hospital so a team is ready when you arrive.
Don't take any pills on your own while you wait. The 911 dispatcher will walk you through what to do.
Why it looks different in women
Heart disease is the leading cause of death for women in the United States, according to the CDC, and it can affect women at any age. Even so, many women struggle to recognize their own heart attack.
There are a few reasons for that. Women's symptoms tend to be more varied and less "textbook." Many Hispanic women also juggle the household, a job and the kids, and they're used to pushing through: everyone else gets looked after first, and they come last if there's time left. And the old belief that heart trouble is "a men's problem" still hangs around.
Signs that get mistaken for something else
On their own or together, these can point to a heart attack in a woman. What makes them suspicious is that they show up without a clear cause, feel unlike your usual aches, or come with shortness of breath:
- Fatigue that isn't normal. Not the tiredness of a long day, but the kind that flattens you while doing simple things like making the bed or walking to the bus stop.
- Nausea, vomiting or burning in the upper stomach that resembles indigestion or your familiar gastritis.
- Pain in the back, neck, jaw or shoulders, sometimes in both arms rather than only the left.
- Shortness of breath at rest or with very little effort, even with no chest pain.
- A cold sweat that heat or exercise doesn't explain.
- Lightheadedness or feeling like you might pass out.
- Chest discomfort that isn't sharp pain: heaviness, pressure, a mild squeeze or an empty, hollow feeling.
Heart health guidance makes one more point worth repeating: in women these signs can come and go for hours or even days before the main event. That on-and-off pattern is exactly why they get brushed aside.
"I thought it was anxiety": the usual mix-ups
Talking every day with patients from Spring Branch, the clinic's medical team hears the same explanations again and again. None of them is silly, and each one makes some sense. The trouble starts when they become a reason not to get help:
"It's my gastritis." Burning under the breastbone can feel very similar. The clue is whether it comes with breathlessness, sweating or unusual tiredness, or whether it refuses to ease with whatever normally settles your heartburn.
"It's just nerves." Anxiety can make your heart race and leave you short of breath, but a brand-new symptom shouldn't get that label until someone has checked you. The serious causes get ruled out first.
"It's menopause." Hot flashes and night sweats are common at that stage. A cold sweat paired with nausea or chest pressure is a different story.
"I slept wrong, that's why my back hurts." Upper back pain, or pain between the shoulder blades that doesn't change when you move and shows up alongside other signs, deserves attention.
"I'm too young for that." Risk climbs with age, yet the CDC points out that heart disease can strike women at any age.
What raises a woman's risk
Some risk factors are shared with men, and others are tied to stages of a woman's life. They're worth knowing because nearly all of them can be monitored:
- High blood pressure, which often causes no symptoms.
- Diabetes, which can also dull the pain of a heart attack.
- High cholesterol and triglycerides.
- Smoking, even a little.
- Extra weight and too little physical activity.
- Pregnancy history: high blood pressure while pregnant, preeclampsia or gestational diabetes. Even if the delivery went fine, these details belong in every visit.
- The years after menopause, when heart risk tends to rise.
- Close relatives who had heart problems at a young age.
What you can do before there's ever a scare
Prevention isn't glamorous, but it works. At our Hammerly Blvd clinic you can check several of those factors during a visit.
In diabetes, hypertension and cholesterol care we take your blood pressure while you're seated, rested and with your arm supported, and the lipid panel (total cholesterol, LDL, HDL and triglycerides) is run in the clinic's own lab. If yours calls for fasting, skip breakfast; plain water is fine.
If the clinic's medical team wants a closer look at how your heart is beating, they may order an EKG: a few patches on your chest, wrists and ankles, painless and with no current running through you. Keep one thing in mind, though: a normal EKG at a routine visit can't rule out a heart attack that begins hours later. If warning signs appear, the answer is still 911.
Blood work rounds out the picture with glucose and other values that affect heart risk. And if you're already coming in for gynecology, bring up your pregnancy history: high blood pressure or high sugar during those months is useful information for your heart today.
If you already take medicine for blood pressure, sugar or cholesterol, don't quit it or shift the dose just because you woke up feeling fine one morning: bring the boxes to your next visit and talk with the medical team before changing anything in that treatment.
A list for the fridge door
If it helps, copy this onto a piece of paper and stick it where the whole family will see it:
- Discomfort in the chest, back, neck, jaw or arms that won't go away.
- Shortness of breath, a cold sweat, nausea or dizziness that hits suddenly.
- Extreme tiredness with no reason behind it.
- When in doubt, 911. An ambulance you didn't need beats waiting too long.
One overdue conversation
Plenty of women in Spring Branch and the 77055 area come in for a Pap smear, the kids' lab work or an infection, then leave without having had their blood pressure checked in years. Next time you visit, ask about your pressure and your cholesterol, and if your mom or your aunt is past fifty, bring her along. If the team writes you a prescription, it's sent electronically to the pharmacy you choose, so keep the name and address of the one closest to home handy.
What saved Doña Rosa was a granddaughter who recognized the signs and dialed 911. Be that granddaughter.