When Janet Holmes ?suddenly started feeling dizzy, sweaty and had headaches, she just put it down to flu. the former mayor of ?Wakefield, West Yorkshire, also had a terrible pain just below her shoulder blades.

But because she’d just been walking with her husband on a bitter December morning — it was minus 3c — she assumed this was down to the cold. ‘so I took two aspirins and went to bed with a hot water bottle to try to warm up.’

But when she got up the next morning, Janet felt a crushing pain in her chest which went through to her back.  

Delayed diagnosis: Janet Holmes put her heart attack symptoms down to flu

‘It felt like someone was smashing a ?hammer in my chest,’ says Janet, 68. ‘then it dawned on me I might be having a heart attack. even then I didn’t think it was serious enough to call an ambulance and asked my husband Brian to drive me to A&E.’

Janet was given an electrocardiogram (ECG) to measure her heart’s electrical ?activity, but the nurse said the results were fine. ‘I asked for more pain relief, but the nurse said I’d already had two ?paracetamol and he had other patients to see. I was bent over double with chest pain. I felt like my heart was going to explode and was extremely frightened. 

‘I’d been in hospital two hours by then and had still not seen a doctor, so my ?husband found one and made him come and see me. I had another ECG and my heart attack was finally diagnosed.’

Janet was treated with clot-busting drugs and taken by ambulance to a specialist ?cardiac centre in a different hospital. Tests revealed four arteries were partially blocked and she’d need a quadruple bypass operation — where blood vessels are grafted from another part of the body. She was too unwell to have the ?operation for two weeks. However, since the surgery in January, she has ‘felt fine’.

THE WARNING SIGNS YOU SHOULDN’T IGNORE

The characteristic signs of a heart attack are crushing pain in the centre of the chest (which can spread to the arms, neck or jaw), as well as feeling sick or sweaty and/or shortness of breath.

Less common symptoms, thought to be more common in women, but also ?affecting men, include:

Feeling as if you have a bad case of indigestion.

Dull pain, ache, or ‘heavy’ feeling in the chest.

Mild discomfort in the chest that makes you feel generally unwell.

Light-headedness or dizziness as well as having chest pain.

Chest pain spreading to the back or stomach.

She says: ‘the delay in diagnosis could have cost me my life. It didn’t help that I didn’t ?recognise my symptoms as a sign of a heart attack, but I can’t help thinking it might have been diagnosed sooner if I was a man.’

Like millions of women, Janet’s heart ?disease symptoms were overlooked because doctors — and patients — still regard the condition as affecting mainly men.

Yet women’s deaths from heart and ?circulatory disease are outstripping men’s — 99,000 women under 75 died of heart and circulatory disease in 2008 compared with 91,000 men, ?according to the British Heart Foundation. 

There are more than a million women registered as living with heart disease, but experts say many go undiagnosed. in a survey, one in ten women aged 50 or older said their doctor had never ?discussed heart disease with them. 

As Mike Knapton, a GP and ?associate medical director at the British Heart Foundation, says: ‘If you ask GPs, they’ll say they are aware of the risks of heart disease in women. but our survey clearly shows the subject is not being raised enough with them.’

The survey found only 47 per cent of women would call 999 if they were suffering the  symptoms of a heart attack — many did not realise the danger of their symptoms.

One problem is women’s ?symptoms (see box above) can be slightly ?different, says Dr ? Knapton. ‘People are still hooked on the myth of the Hollywood heart attack, where a stressed-out, ?middle-aged ?businessman collapses clutching his chest,’ says Dr Knapton. ‘but heart attacks can be less dramatic than that and just make you feel tired and have pains in your back or jaw.

‘Women may be less likely to have central chest pain and may have more atypical symptoms like acute vomiting, sweating or ?feeling ?generally unwell, although the ?evidence for this is not clear-cut.’ 

It’s thought these differences might be due to women’s different physiology and pain perception.

‘Women tend to make light of their symptoms, so they are less likely to be investigated  and treated promptly,’ adds Dr Knapton.

The equipment used to diagnose heart attacks can cause problems for women, says Dr Ghada Mikhail, a consultant cardiologist at ?Imperial College, London. ‘even when they get to hospital, it is harder to ?diagnose a heart attack in women, as abnormal heart rhythms in females are more ?difficult to pick up with ECG equipment.’ 

Some experts believe oestrogen interferes with electrical activity in the heart — guidelines say ?electrocardiograms should be read only by health professionals who have received ?training in how to ?recognise abnormal ?electrical activity.

‘Women also have smaller ?coronary arteries, so procedures to insert stents (tubes to open up the arteries) or perform bypasses can be more challenging,’ says Dr Mikhail.

But as well as lack of ?awareness about heart attacks in women, there’s also a failure to understand the risk factors and symptoms of heart disease, says Dr Knapton.

For most women, breast cancer remains their ‘number one health fear’, adds Peter Collins, ?professor of clinical cardiology at the Royal Brompton Hospital. He says: ‘in fact, they are ten times more likely to die of heart disease.’ 

Heart disease kills three times more women each year than breast ?cancer. ‘Their misconceptions are partly due to women developing heart disease later than men.’ the female sex hormone ?oestrogen is thought to ?protect women’s hearts until the ?menopause. ‘A 65-year-old woman has the same risk of cardiovascular ?disease as a 50-year-old man — but that doesn’t mean they are at no risk,’ says ?Professor Collins.

‘we are trying to ?encourage ?physicians who see women about their menopause symptoms to be more proactive about screening women for their heart disease risk factors such as being overweight or having high blood pressure.’ the British Heart  Foundation is advising women over 40 to ask for a heart check-up from their GP.

‘Too many lives are lost each year to a killer which is largely ?preventable,’ says Dr  Knapton.

Janet Holmes, who has a son and four grandchildren, wasn’t a ?typical heart attack victim — at 5ft 3in, she weighed 8st 7lb, had normal blood pressure and a ?cholesterol reading of 4.8 (under 5 is ideal).

‘the only risk factors I had was the fact I smoke the odd cigarette, my father died of a heart attack and two of my brothers had heart attacks in their 50s. 

‘looking back, I’d been unwell for two years — I suffered from ?tiredness and my sisters used to worry because I was thin and pale and always looked exhausted. my doctor had never discussed heart disease with me and was shocked when I had the heart attack.’

‘Ironically, I was always more ?worried about my husband’s health than mine — he had high blood ?pressure — and I was always ?anxious he shouldn’t overdo it.’

Janet urges all her friends to have their heart disease risk ?factors checked. she adds: ‘I thought heart attacks were something that ?happened to men — my ??ignorance nearly cost me my life.’

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