Nicole Nickerson is 36 years old and has already had two heart attacks.
The first happened the same year her younger sister died unexpectedly of heart disease in 2014. The second came four years later while she was pregnant with her second child.
Nickerson, of Lunenburg, N.S., said she wants other women to be advocates in emergency rooms because women's heart attack symptoms get overlooked.
"Even though both times I wasn't sure I was having a heart attack, I knew something was wrong. You really need to learn to not take no for an answer and get that second opinion," Nickerson told CBC's Mainstreet from her home.
"If all else fails, say chest pain, because that is the language they understand."
A report from the Heart and Stroke Foundation found early heart attack signs were missed in about 53 per cent of women.
While the most common sign of a heart attack in both men and women is chest pain, women are more likely to experience symptoms such as fatigue, nausea, shortness of breath, light-headedness, and chest or upper body discomfort.
Dr. Sharon Mulvagh, a Halifax cardiologist, said women often do experience typical heart attack symptoms, but they communicate it differently, using words like pressure, tightness or aching.
"You have to be more of a detective to get the story of chest pain from a woman than a man," Mulvagh said.
"It's because that's what we've been taught ... we've learned the male model of a heart attack."
While many heart attacks are caused by a blockage in the artery, Mulvagh said women are more likely to have problems caused by small vessels, tears or even spasms in the coronary arteries.
Nickerson was only 30 when she had her first heart attack, nine months after her 25-year-old sister died from heart disease.
"It was a complete shock to the family, so I decided to come home and get myself checked out," she said. "Everything looked fine."
A month after the stress test, Nickerson went to the local emergency department with chest pains.
"They told me it was impossible for me to be having a heart attack because I had just passed a stress test the month before," she said.
After being sent home, Nickerson said she was in pain for two more days before a family friend — a retired nurse — told her to get a second opinion.
"I was informed that I did indeed have a heart attack," she said. Nickerson needed a stent — a tube that's meant to keep blocked passageways open.
Not 'just anxiety'
Nickerson's family has a history of heart disease. Her mother had a heart attack at 30 and her father had to have an emergency quadruple bypass at 40.
Her second heart attack happened in 2018 while she was pregnant with son William.
"Ironically enough on the anniversary of my sister's death, Jan. 9, I really, really wasn't feeling good. I just thought it was just anxiety, it's a hard day."
After dinner that night, she went to the emergency room at a hospital she said knows her family history.
But it was still difficult to confirm: Nickerson's blood work showed her levels of troponin — proteins important in helping the heart muscle contract — were in the grey area and not enough to concretely say she was having a cardiac event.
"So I had to stay there until the second troponin came back, and they realized I did have a heart event, and at that point they thought I was going into labour," Nickerson said.
She was put on a Lifeflight helicopter to Halifax, where she stayed for a week.
Once she was stable, she had a C-section and was taken back to the coronary care unit, where they told her she needed another stent.
Rising incidences of heart attacks
Mulvagh said they are seeing an uptick in heart attacks for women in their mid-30s to mid-50s.
"We don't exactly know why that that is, but a big suspicion is lifestyle issues," she said.
"Two-thirds of heart disease clinical research has focused on men and that is why we are really at a loss to be able to have the information ... in understanding the reasons why."
But Mulvagh said that research is moving forward to include more women in studies.
A plea for volunteers
"Women really need to step up and volunteer in research studies," she said. "It is really important that if a woman is invited into a research trial that she really accept the invitation and participate."
Nickerson said the possibility of a third heart attack is something that's always in the back of her mind.
But she said she feels hopeful because there is now more research happening around women's heart health.
"And I think that outweighs the fear I may have."
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