Among the potential signs of a heart attack or blocked coronary artery, chest pain and left arm pain are two of the more commonly known—they aren’t however, the only ones you should be able to recognize. Women, especially, can have subtler or more unusual symptoms of heart problems, which they often fail to notice, or incorrectly dismiss as something else altogether.
A “Message” from Mom
At first, Tammy Jones, manager of patient registration at Sentara RMH Medical Center, ignored the signs her body was giving her that something was wrong with her heart. Just a few months shy of her 60th birthday, she was feeling tired and run down. Walking up stairs was also getting harder and harder, but her symptoms were vague enough that they didn’t concern her.
“I blamed it all on getting older, telling myself I wasn’t the young chick I used to be,” Jones laughs. But then the Staunton resident says she received a message she couldn’t ignore. The message, she believes, was from her mother, who had died from a heart attack years before.
Jones, who has worked at Sentara RMH since 1977, doesn’t smoke, isn’t obese, and doesn’t have diabetes, but due to her family history, she knew she needed to keep an eye on her heart—her mother died of a massive heart attack at age 64, and her father died of a ruptured aortic aneurysm at age 60. Her mother’s only complaint had been back pain, which can be a symptom of heart attack in women.
On top of her increasing fatigue, Jones’ medical issues escalated suddenly one weekend in February 2018, when she and her husband, Ronnie, had their living room floors redone. After exerting herself moving furniture around, she started feeling tension between her shoulder blades.
“I was hurting, but I just thought: ‘That’s normal for me; I’ve overdone it,’” she recalls.
By the following Wednesday, however, the back pain still had not gone away. For some reason, she couldn’t let go of the nagging memory that her mother’s only heart attack symptom had been back pain. So to be on the safe side, Jones left work and went to the Sentara RMH Emergency Department (ED).
An electrocardiogram (EKG) showed no signs of heart disease, but because of her family history, her primary care provider referred her for a nuclear stress test a few days later. The stress test uses a small amount of radioactive tracer to create pictures that show the flow of blood to the heart while a patient is resting and while exercising on a treadmill.
“I knew by the look on the nurse’s face that I wasn’t going home right away,” Jones remembers. Instead, she saw Sentara RMH interventional cardiologist David McLaughlin, MD.
“I was really relieved Dr. McLaughlin was on call,” she says. “I’d heard a lot of good things about him, and by that time Ronnie and I were really scared.”
A Serendipitous Diagnosis
Jones’ nuclear stress test results showed EKG changes during the treadmill portion of the test. Dr. McLaughlin decided Jones needed a cardiac catheterization. The “heart cath” is a procedure during which a thin tube is inserted into an artery or vein in the patient’s arm, neck or groin and threaded to the coronary arteries that supply blood to the heart. Catheterization often can reveal blockages in coronary arteries that other tests cannot.
Jones was a bit anxious, but she says the procedure was simple and painless. Her heart cath revealed she had two severely blocked arteries. Dr. McLaughlin opened the blocked arteries and inserted two stents to keep them open and allow normal blood flow to Jones’ heart.
“Fortunately,” says Dr. McLaughlin, “Tammy didn’t have any heart damage and did not have a heart attack.”
As it turns out, the back pain she experienced really was just due to pulled muscles.
“The back pain was a red herring, but it brought Tammy into the ER,” says Dr. McLaughlin. “It was the fatigue that she was experiencing with exertion or exercise that was her real heart symptom. Women frequently have vague symptoms of heart disease, like the fatigue Tammy was experiencing.”
Jones sees the upper back pain she experienced as more than just a lucky coincidence. “It had nothing to do with my heart,” she says, “but it’s what made me go to the ED. God—and my mom and dad—prompted me to go. I’d ignored everything else, but they knew I would not ignore that back pain. It made me think of my mom.”
A Heart-Healthy Lifestyle
Now, after completing 18 sessions of cardiac rehabilitation, Jones says she realizes the importance of exercise and diet in maintaining a healthy heart. She walks daily, rides an exercise bike at home and does some light weightlifting. She also eats healthier and watches her portion sizes.
“I’ve got my energy back,” she says, happily. “Tammy feels like Tammy again.”
Jones hopes that by sharing her story, other women will take notice and learn not to ignore the signals their bodies are sending them.
“Pay attention,” she stresses. “I could’ve been my mother. I could’ve been that person who just drops dead. Women need to know that potential symptoms of coronary issues are easy to mistake for signs of ‘just getting older.’”
Three Separate Heart Attacks
Juanita Conley, 71, has had three heart attacks in the past decade, and each time, she says, the symptoms surprised her. She’s never had chest pain, shortness of breath or any of the “typical” signs of heart trouble.
The first episode occurred one morning in 2010. Conley woke up with what she thought was a bad case of heartburn, so she called her primary care physician’s office. The nurse she spoke with suspected a heart attack. Conley was confused—she only wanted some pills to ease her heartburn. Instead, the nurse asked her to take aspirin and call the rescue squad immediately.
“I have the greatest respect for nurses, but I thought she was being overly dramatic,” says Conley, who lives in Greene County. Still, she did as she was told, and when she arrived at the Sentara Martha Jefferson Emergency Department, tests revealed that the nurse’s suspicions were correct. Conley was further assessed by cardiac catheterization and given two stents to open her blocked coronary arteries.
“I only called the rescue squad to appease the nurse, but I’m glad I did,” she says. “I now know that heart disease symptoms aren’t always obvious. I didn’t believe I was having a heart attack. To me it felt like indigestion.”
Conley’s cardiologist, Timothy Williams, MD, of Cardiovascular Associates of Charlottesville, a practice within the Sentara Martha Jefferson network, says gastrointestinal symptoms such as heartburn, nausea and vomiting are fairly common signs of heart attack in women.
“Men also can get gastrointestinal symptoms, but it occurs more frequently in women,” Dr. Williams says.
While Conley doesn’t have high blood pressure, she does have a strong family history of heart disease, a risk factor for heart attacks in women and men, and she smoked for many years before quitting.
“Smoking is probably the greatest risk factor for heart attack,” says Dr. Williams. “There are ways to combat family history: stop smoking, lose weight, exercise and eat a heart-healthy diet. There’s always risk, but you can dramatically lower your risk by making a few key lifestyle changes.”
During a subsequent heart attack in 2013, Conley’s jaw was aching. Feeling like something serious was occurring, she quickly called the rescue squad—a call that almost certainly saved her life. In the ambulance on the way to the hospital, she went into cardiac arrest, but a defibrillator shocked her heart back into rhythm, and at the hospital she received a third stent.
“I love Dr. Williams,” Conley says. “With my second heart attack, he was standing right there when they opened the doors of the rescue squad. He grabbed the end of the stretcher and helped get me out of the ambulance.”
Four years later, in 2017, as she was prepping for a colonoscopy, Conley broke out in a tremendous sweat. According to Dr. Williams, jaw pain and sweating also can be signs of a heart attack, especially in older individuals.
Worried about the symptoms she was experiencing, Conley once again called the rescue squad and sat down and waited. “I had the strangest feeling—like I was sitting in the chair, but I was also above the chair. I could feel myself leaving,” she recalls.
Today, Conley is taking better care of herself, watching what she eats and reducing the sodium in her diet. She also takes several medications to help prevent further blockages.
“I have nothing but praise for everybody at Sentara Martha Jefferson Hospital, and especially for Dr. Williams,” Conley says. “I recommend them all the time. They really care about their patients—not only when you’re sick, but also when you’re well.”
Pay Attention to Your Body
Dr. McLaughlin and Dr. Williams emphasize that women frequently have less pronounced heart disease symptoms than men. They note that both women and men should understand their individual risk factors for heart disease, know their family history of heart disease, and be sure not to ignore any signs or symptoms they may be experiencing—even if they’re not the typical, classic signs of heart disease. For Tammy Jones and Juanita Conley, reacting quickly to their symptoms literally made the difference between life and death.
If you happen to experience symptoms that could be signs of heart trouble, be sure to seek immediate medical attention.