Movies and TV programs often depict a man having a heart attack. He clutches his chest, gasps for breath, and falls to the floor. Rarely do women appear in a similar scene. In real life, however, heart attacks take many different forms, said Marcus Averbach, MD, of St. Luke’s Cardiology, and are as likely to happen to older women as older men.

“Women tend not to have as much cardio illness before menopause, partially because the high level of estrogen in their bodies provides some protection against it. Once women go through menopause, however, they catch up quickly with men,” said Dr. Averbach, who sees patients in the Bethlehem, Easton, Quakertown, and Wind Gap offices.

Most women have similar symptoms to men when having a heart attack; however, they are more often present with atypical systems.

The American Heart Association lists the following symptoms as signs a woman could be having a heart attack:

As with men, women’s most common heart attack symptom is chest pain or discomfort that often radiates down the left side or arm, Dr. Averbach said. However, women may experience other symptoms that are less associated with heart attack, such as shortness of breath, nausea and vomiting, and back or jaw pain.

“It’s not as clear cut as men present one way and women another,” he said. “However, women often relate to their symptoms differently, downplay them or brush them aside.” They may attribute their symptoms to stress or perimenopause.

Kim Krug of Pennsburg, a Global Director for Johnson & Johnson, attributed her heart attack symptoms to stress after a challenging week involving complex personnel issues. She experienced persistent chest pain. When the continuously worsening pain made it impossible to sleep, she drove herself to St. Luke’s Upper Bucks Campus, near Quakertown, with the hope of pain relief. The emergency room physicians, however, suspected a heart attack and conducted tests. Dr. Averbach, who examined her in the ER, said her EKG was normal, but her blood tests showed high levels of troponin, indicating she was having a heart attack.

Krug experienced a non-ST-elevation myocardial infarction (non-STEMI) that happens when the heart can’t meet its need for oxygen. Dr. Averbach had Kim transferred by ambulance to St. Luke’s Anderson Campus, where an on-call team led by interventional cardiologist Luis A. Tejada, MD, performed an angioplasty and placed a stent to fix a 100 percent blockage in her left anterior descending artery (LAD), the so-called “Widowmaker” blockage. The catheterization and stent restored the blood flow to her heart, saving her life.

“In hindsight, I can’t believe I drove myself to the hospital,” Krug said. “I downplayed it. I ignored it. My denial was so strong.” She knew chest pain was a sign, but because she didn’t have other symptoms, like sweating or shortness of breath that often accompany heart attacks, she attributed it to stress.

Looking back, she acknowledges she was at risk for heart disease. She smoked, didn’t exercise, was overweight, and had Type II diabetes. Her job required her to work long hours, sit at a desk, and meet with people in different time zones, which affected her sleep.

“I was only 50 when I had my heart attack,” she said. “I was at the pinnacle of my career and living a good life. I had risk factors but was in denial about them. I thought my lifestyle would catch up to me in my 70s or 80s if I didn’t change my ways, but not now.”

By waiting to seek help, the attack damaged her heart muscle, leaving her with an ejection fraction (EF) of 35%. An EF of less than 50–55% indicates the heart isn’t pumping correctly. The lower the EF, the weaker the heart function.

After her heart attack, Kim enrolled in cardiac rehabilitation at St. Luke’s Quakertown, where she could safely exercise while being monitored by a team of healthcare professionals. Her EF increased to 45%, and the support she received from the Cardiac Rehab team and the camaraderie with other patients helped her cope with her fears and regain her confidence.

“The Cardiac Rehab team were the ones who helped me heal,” she said. “I did everything they told me to do. I attribute my success to them. It’s an unbelievable program.” She continues to work out regularly at a local gym, now sees a therapist to help with stress, and has lost 60 pounds through a healthier diet and regular exercise.

Dr. Averbach said recoveries like Krug’s are common. Even people with severe heart attacks can recover and go on to live years or decades afterward without much of an issue. Today, physicians can treat patients with powerful drugs that strengthen the heart. That, combined with lifestyle modification, can significantly improve health and longevity.

“But it’s even better to prevent a heart attack by lowering your risk factors,” he said. “See your PCP regularly. Try to incorporate aerobic exercise several times a week. Nobody’s perfect but try to eat healthier and maintain your weight. And if you smoke, do whatever you can quit. Prevention is the best way to live a long, healthy life. We do all of these things on the back end to fix people after they have a heart attack, but the number one thing we can do to ensure people lead healthy lives is to prevent it in the first place.”

And while Krug can’t go back in time and prevent her heart attack, she’s determined to prevent a second one.

“My heart attack blew my whole life up,” she said. “Besides the physical harm, it was mentally traumatic. I love my life and I wanted it all back. Now, it’s better than ever.”