By the time a nurse finally checked her heart rate and blood pressure, “they thought something was wrong with the monitor,” she says. An electrocardiogram (EKG), which records the heart’s electrical activity, showed a “tombstone rhythm,” indicative of a 100% blockage: a massive heart attack. Doctors would later suspect the tear in an artery, or SCAD, that caused the event likely happened when she first felt pain weeks prior, and over time, limited more and more blood from reaching her heart.
In other scenarios, these kinds of unusual and predominantly female heart attack types aren’t even obvious on tests for heart issues. A non-plaque-related blockage won’t necessarily spark an abnormal EKG, Dr. Reynolds says. “You have to ask for a blood test that checks your level of troponin,” which leaks from a damaged heart, to know for sure if you’ve had a heart attack, she says. But even this doesn’t indicate the cause. And when a doctor visualizes your arteries (via a coronary angiogram) to determine what went wrong, “you don’t always see anything, like you would with a plaque-related blockage,” Dr. Ahnert says. A small artery tear or spasm, for instance, may be invisible or heal on its own prior to the scan.
That means, if a woman’s heart stabilizes, she may be sent home without learning the underlying reason for her attack or getting treatment for it, Dr. Ahnert says. In fact, the 2018 study above on rising rates of heart attack in young women showed that they are less likely than men with the condition to receive certain medications to thin blood and safeguard the heart (despite facing similar risks of death or a future cardiac issue).
How to lower your odds of having a heart attack—or long-term damage from one
Your first step, all the experts say, is to get a sense of your personal risk, no matter how young you may be. “When you’re in your 20s or 30s, or even early 40s, you’re not necessarily thinking about your blood pressure, cholesterol level, or sugar control,” Dr. Lau says, “but it’s critically important to have these factors on your radar.” It’s the cumulative exposure [to these risks] that really wreaks havoc on your heart, she points out.
