Important notice: Life-threatening chest pain is not always left-sided. Clots can occur in either lung; heart attacks can also present centrally and rarely on the right.
This post focuses on life-threatening chest pain and reasons to seek help immediately. You will see that left side chest pain in women should be taken more seriously than it is.
For some reason, people think of men when they think of heart attacks.
We, as medical students, learn that being male is a risk factor for cardiovascular disease. This couldn’t be further from the truth.
In 2019, cardiovascular disease killed more women than men in Europe.
Cardiovascular disease (CVD), of which ASCVD is the major component, is responsible for >4 million deaths in Europe each year. It kills more women (2.2 million) than men (1.8 million), although CV deaths before the age of 65 years are more common in men (490 000 vs. 193 000) 1
At a conference in May 2023 called Heart Failure 2023, the European Society of Cardiology (ESC) confirmed that women are more than twice as likely to die after a heart attack than men.
Left side chest pain in women, especially ages 35 to 54, needs more attention. According to Virginia Colliver, M.D., a cardiologist, heart attack rates in younger women are increasing in the USA.
“I can believe this. In another article, I discussed how rates of high blood pressure had increased in young patients in my Cape Town practice. Reasons, in my opinion, include chronic stress, poor lifestyle, and abuse of energy drinks.”
Also read: Blood Pressure Numbers By Age ∣ BP Basics 101
Also read: Tricks To Lower Blood Pressure Instantly ∣ Fact Or Fiction
In the eye-opening 2011 TED talk below, C. Noel Bairey Merz says that heart disease kills more women than breast cancer at all ages. The British Heart Foundation made the same observation in 2019.
In 2023, breast cancer screening campaigns continue to save lives. There is still little awareness of heart disease in women.
Dr. Merz also mentions that left side chest pain in women may present differently to men.
Women erode. Men explode. Symptoms (in women) are subtle, and ECG findings are different.
C. Noel Bairey Merz, Physician
Why am I writing this post?
A life was lost this week that could have been prevented; this motivated me to write this post.
Often, when you hear someone passed because of chest pain, there is a backstory lasting a few days.
What should you do if you have chest pain? It seems there is an urgent need for education.
Left side chest pain in women or men could be life-threatening or nothing serious. The only way to tell the difference is to visit a doctor.
Take chest pain seriously. This is my message.
“Time and time again, I see patients who delay seeking advice about their chest pain.
I’m not quite sure why this happens. It might be a combination of:
- Denial
“I don’t want something serious to be wrong.” or “I’ll wait and see what happens.”- Self-consciousness
“I don’t want you to think I’m overreacting.” or “I didn’t want to waste your time.”- Being over-extended
“I just didn’t have the time to check it out.”
This post aims to save lives.
Time is critical.
Do not wait for days.
Where should I go if I have chest pain?
You need to be aware of red-flag symptoms and risk factors.
I will cover both in the next section.
“If you have red-flag or high-risk chest pain, the place to be is at a hospital. Here, investigation, diagnosis, and treatment are immediate.”
Patients often come to us, their family doctors, because they know and trust us. However, in a situation with red flags and risk factors, the likelihood of pain being life-threatening increases. You think we are superheroes, but we are not ER staff, cardiologists, pulmonologists, or critical care specialists.
Do not wait overnight or until the next available appointment to see your GP.
The longer treatment is delayed, the more potentially irreversible damage is done.
I worked in Johannesburg for 18 years at a family practice. During this time, five patients with red flag symptoms drove past the casualty department to get to our rooms. Two of these patients died in the car between the hospital and our GP practice.
Call an ambulance or go directly to the emergency department.
What are the causes of left side chest pain in women and men?
The causes are the same in women and men, even though presentations sometimes differ.
Life-threatening chest pain causes
Important notice: Life-threatening chest pain is not always left-sided. Clots can occur in either lung; heart attacks can present centrally and rarely on the right.
The two main causes here are
- Heart attacks
- Lung blood clots
Refer to the checklists below to screen for life-threatening chest pain.
During heart attacks, the intensity of the pain can differ. Some patients don’t describe it as pain, just a tightness. This intermittent tightness, plus some shortness of breath and atypical ECG changes, may lead to a misdiagnosis of asthma. This happened to one of the three ladies in the podcast below, Women and Heart Disease.
Women experience nausea or vomiting more frequently than men during a heart attack, according to the British Heart Foundation.
The checklists for life-threatening chest pain
- red flag symptoms, and
- risk factors.
If you check off any criteria in these two lists, go immediately to your nearest emergency department.
Do not use your GP’s rooms, if possible, in these circumstances.
Red flag symptoms of life-threatening chest pain
- A pain, pressure, ache, tightness, grip, or squeeze, especially occurring when you get your heart rate up
- Pain, ache, or gripping feeling moving into your neck, jaw, back, stomach, or down your arm
- Shortness of breath associated with the pain
- Dizziness, lightheadedness, or disorientation associated with the pain
- Fatigue associated with the pain
- Painful swollen leg/s
Risk factors for life-threatening chest pain
- Previous heart attacks
- Family history of heart attack or stroke
- Previous leg clots, the medical name is deep vein thrombosis (DVT)
- Previous lung clots, the medical term is pulmonary emboli (PE)
- Family history of DVT or PE
- High blood pressure
- High cholesterol
- Diabetes
- Smoking
- Recent surgery
- Recent overseas travel
- Contraceptive pills or hormone replacement therapy use
Other causes of chest pain
Muscular causes
Hints that it might be muscular are pain with movement and increased discomfort when pressing on the area of pain.
Overuse
Overdoing upper body workouts at the gym, for example.
Pleurodynia
Pleurodynia, also known as Bornholm disease or Devil’s Grip. This is a viral inflammation of the muscles between the ribs.
Photo by Li Sun: https://www.pexels.com
Gastroesophageal reflux
A fancy term for heartburn. It can be central or left-sided. Often worse after eating or when lying down.
Lung causes
Pleurisy
This is inflammation of the membranes between the inside of the chest wall and the lungs.
Breathing, and sometimes movement, is painful.
Chest infections
This can sometimes cause pleurisy. There may be coughing and fever.
Photo by Anna Shvets: https://www.pexels.com
Nerve causes
Shingles
Shingles is a reactivation of chickenpox. The pain is usually an ache or burn. It occurs on one side of the body in a strip called a dermatome. Very often a blistering rash develops in the area of pain.
Nerve compression
This is a pinched nerve in the spine. It is an ache, burn, or electric-shock-type pain. Also one-sided in a dermatome.
Emotional causes
“This is a diagnosis of exclusion. Doctors must rule out all other causes before suggesting stress as an explanation for chest pain.”
I’m sure most of us have experienced heartache. Panic attacks, chronic anxiety, and low moods can cause emotional chest pain. A common cause of visits to the emergency department.
Other heart causes
Pericarditis and carditis
These are rare causes. Inflammation of the membrane covering the heart and the heart muscle, respectively.
Summary of left chest pain in women
- Women also die from heart attacks. It is not just a men’s disease.
- Heart attack symptoms in women may be subtle. Women are less likely to experience that clutch-your-chest-and-collapse-pain seen in the movies.
- You must see a doctor for any chest pain.
- Seek help immediately if you have any red flags or risk factor checks.
- If you have red flags or risk factors, choose an emergency department over a GP’s office.
This is a very interesting read. I sped off to casualty late last year with chest pain – Code Orange classic heart attack symptoms. After a few CT scans. Ample stealing of my blood determined severe esophagitis attack – same severe symptoms as a heart attack.
I am glad that you enjoyed the post. Every chest pain should be considered life-threatening until proved otherwise.