"Is this pain from my heart or not?"

I find this question often difficult to answer for women who have concerns about their heart health. Women can have classic heart symptoms, but they also can have very unusual symptoms. Sometimes I tell my women patients that anything above your navel and below your nose is fair game for heart pain.

One of my most memorable experiences was of a woman who had chest pain only when she bent over, which is not a usual symptom pattern for heart-related pain. I followed protocol and did an ECG, which turned out to be abnormal. Subsequently, she had surgery to bypass her blocked artery and this relieved her pain. She had been very insistent that something was wrong, and not only was I happy I listened to her, but I was glad she advocated for herself. She listened to the little voice in her head that said, "I just don't feel right."

My message to women (and men): When in doubt, check it out!

Often test results reveal that symptoms are not heart-related, and some patients - particularly women - worry that they will feel foolish or embarrassed. My message to them is to jump with joy if your tests are good and pat yourself on the back for using an expert to answer your questions. Remember, your health care provider went through years of training to be able to help you answer the question: "Is this pain from my heart or not?"

Unusual fatigue and shortness of breath are symptoms that are particularly common for women who have heart disease. Here are some signs and symptoms of heart attack and pre-heart attack (angina) pain:

• Angina: pain, discomfort, pressure or tightness in the middle of the chest that lasts for more than a few minutes or goes away and then comes back; sometimes mistaken for heartburn
• Pain or discomfort in the upper body, including arms, left shoulder, back, neck, jaw or stomach
• Difficulty breathing or shortness of breath
• Cold sweat or sweating
• Feeling of indigestion, choking or heart-burn
• Nausea or vomiting
• Feeling dizzy, light-headed or extremely weak
• Feeling anxious
• Rapid or irregular heartbeats
• Unusual fatigue
Lynn Hoke is a nurse practitioner at the University of Minnesota's Women's Heart Clinic.

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