Why Your First Heart Attack Could Be Fatal—Critical Warning Signs with Dr. Jayne Morgan
Show Snapshot:
Your heart attack won't look like the movies—and that ignorance is killing women. Dr. Jayne Morgan, renowned cardiologist and VP of Medical Affairs at Hello Heart, shares a shocking truth: women wait 37 minutes longer for care than men, and each minute increases your risk of dying. Discover why fatigue and jaw pain might be your body's SOS, how menopause impacts your natural heart protection, and the one phrase that gets immediate ER attention. Heart disease is women's #1 killer, yet we're dismissed as "atypical." Arm yourself with knowledge that saves lives, beauties—starting now.
Transcript:
Dr. Jayne Morgan 0:00
In general, there's an average of a 37-minute delay in a woman getting care in comparison to a man. And you may say that's not really a long time. That's not even an hour, but when we're talking about heart disease and heart injury, for every five minutes of a delay in opening a vessel and reperfusing your heart, it increases your risk of death, and that is why the first heart attack of a woman is more often fatal than that of a man, because of this 37-minute delay.
Katie Fogarty 0:35
Welcome to A Certain Age, a show for women who are unafraid to age out loud. I'm your host, Katie Fogarty. Beauties, today's show has critical heart health information for you and for every woman you love. Here's the word that's been getting out slowly. Not enough women know this. Heart attacks don't always announce themselves with crushing chest pain, especially in women, and here's why this matters. Heart attacks are the number one killer of women, and heart attacks in women often whisper with subtle symptoms. Think fatigue, jaw pain, shortness of breath. These are things that we can chalk up to stress or aging or simply a bad night's sleep. Today, Dr. Jayne Morgan, a leading cardiologist and vice president of medical affairs at Hello Heart, reveals some really troubling news. Women are seven times more likely to be misdiagnosed during a heart attack, and she shares the warning signs hiding in plain sight that could save your life. Because here's the cold, hard truth: heart disease kills more women than all cancers combined, yet too many still think of it as a man's disease, which is why women wait longer to seek care, and when they do, their symptoms are often dismissed. And for women, a first heart attack is more likely to be fatal than for men. Let's change that. Today's conversation on heart health and how heart attacks show up differently in women might just be the most important conversation, the most important show you tune into all year long. Welcome to A Certain Age, Dr. Morgan.
Dr. Jayne Morgan 2:16
Hi. Thank you, Katie, for having me.
Katie Fogarty 2:18
I am extremely excited. This is such an important conversation. I know that you have information, tools, resources that truly are going to make a difference for my listeners. Thank you so much for being with me today, and I want to kick off by asking, sort of specifically, the listeners of my show are 45 to 65. We are in our perimenopause menopausal years. How does menopause impact cardiovascular health? And at what stage does risk really begin to increase?
Dr. Jayne Morgan 2:48
You know, such a great question. And perimenopause really can start as early as your mid-30s and so I like to say it doesn't mean that you're not fertile. Doesn't mean that you're not ovulating. Doesn't mean that you can't get pregnant or have children or even expand your family. It simply means that your estrogen and progesterone levels are starting to fluctuate a bit. They're not necessarily always following that 28-day cycle of rising and falling, so there may start to be some fluctuation as your estrogen and progesterone levels start to decline slowly. Again, I want to be clear, you're still fertile at this period, so if you're not interested in having children, you really still do need to take birth control. So don't say that you came on to this podcast and I said you were in perimenopause, so you can certainly be both. So that's kind of the fun period. So it could start as early as your mid-30s. And so what that means from a heart health perspective, you may say, why is a cardiologist even talking about this? What that means from a heart health perspective is that estrogen is one of the protectors of the heart for women. It's an anti-inflammatory agent. It also has direct anti-cardiotoxicity properties, and it's one of the reasons why a woman's risk of a heart attack is half that of a man's prior to menopause, and then once she reaches menopause, meaning you've gone 12 full months without a menstrual cycle, your risk actually equals that of a man. Why is that? It's because of that loss of estrogen. So that's why a cardiologist is talking with you about it. Because menopause is not necessarily a reproductive change, it's actually a change of increased cardiovascular risk, so maybe it's both things. So that's why a cardiologist is here today.
Katie Fogarty 3:42
Dr. Morgan, you used a phrase that I've never heard before, cardiotoxicity. What is that? And talk to us about the link between menopausal changes and increased cardiotoxicity.
Dr. Jayne Morgan 5:00
Yeah, cardiotoxicity just means that the estrogen is protecting your heart from any harmful effects that may occur. That's because there are estrogen receptors on the heart, and so estrogen binds to those receptors on the heart and provides some protection. There are estrogen receptors actually all over a woman's body. It's not just in the uterus and on the breast, which is what most people believe, but the fact of the matter is, estrogen receptors all over our bodies, including our brains and including our hearts. In fact, there's a really good connection between the heart and the brain. What happens in the heart we can often see reflected in the brain. So women, men as well, who have had prior heart attacks, but especially women, also have a further increased risk of dementia. So if you want to protect your brain and protect yourself from dementia, the best way to do that is to do whatever you need to do to protect your heart, because what happens to your heart actually is reflected in the brain. Well, let's talk about that. Let's talk about how we protect our heart. So if we are coming to you, let's just say we're perimenopausal. What are some steps we need to take, and do they differ really from what we're doing in our post-menopausal years? Yeah. And so if you're perimenopausal, meaning, let's say you're around 35 and you may actually be starting to have symptoms, and you don't even recognize them as symptoms of perimenopause or menopause, because nobody's ever taught them to you, and they may not necessarily even be bothering you, but they're kind of new things like an itchy ear, an itchy ear. What does that have to do with perimenopause? Maybe it's allergies. That was actually my very first symptom of perimenopause. I had no idea that it had anything to do with menopause or heart disease risk, but the reason that happens is that your skin can begin to thin a bit with the loss of hormones, and the area in your body with the thinnest skin is in that inner ear. So you might start to get a little itching in that ear, not enough to take you to the doctor. You're not suddenly, certainly not concerned, and it certainly doesn't cross your mind, oh, I might be at risk of a heart attack. My ears are itching. So of course not. This is an example of a small symptom that is somewhat of an annoyance, but nothing that actually might rise to any level of concern or take you to a physician's office, and once you get to the physician's office, they actually may not be able to connect the dots as well. Why? Because we're not taught any of this in medical school. We're not taught it in internal medicine training, and we certainly are not taught it as a part of our cardiology fellowship. And there are other symptoms, maybe just have sort of abdominal bloating and you're starting to get a little gassy. Again, those are symptoms, actually, of your hormones, your estrogen and progesterone levels fluctuating. You may not think about it that way. What did I think? When that started happening, I started to think, oh, I'm getting older. I think I'm developing some lactose intolerance. And again, remember, I'm actually a physician. I've been taught nothing about menopause outside of hot flashes and night sweats, but actually there are probably over 80 symptoms of perimenopause and counting. And the reason these symptoms are important, and a cardiologist is talking to you about them, is that they're not nothing, even though sometimes they're mild annoyances and they're not necessarily interfering with your quality of life. They should be thought of as indicators of an accelerating risk of heart disease, and therefore, what types of steps do you need to take? These are like the little canaries in the coal mine. They're signaling to us that change is afoot, that estrogen is declining, and that we need to be paying attention, because there are big impacts, as you pointed out, to our heart health and to our brain health as well. Some of these symptoms that you mentioned, they're funny unless you're experiencing it, like this itchy ear notion. But you also mentioned hot flashes and night sweats. And hot flashes are not benign. Those are like an alarm bell ringing. What should women be watching for if they're experiencing big hot flashes and night sweats? Is that the time to come in and find a cardiologist, to start to be into the care of a professional? What is your point of view? Hot flashes and night sweats are the two symptoms that everybody thinks about with menopause, and it's an interesting time in a woman's life, because it's really generally not something that's discussed by our mothers or our aunts. Even, I've found even across cultures, not just in my culture, all cultures, there's the big talk about your first period and managing your period. There's never a talk about what happens when the period stops. Like nobody talks about that. But the fact of the matter is that not only do you have rising risk of heart disease, you have opportunities now to take better care of yourself.
Dr. Jayne Morgan 10:00
And so one of the things that occurs as your estrogen levels begin to fluctuate and eventually decline is that you can see a rise in your cholesterol level, your lipids, your triglycerides. And that can be alarming for a number of reasons. But one, again, why is the cardiologist talking to you? Because it's a cardiology risk factor, right? We don't like to see high lipid levels. We treat those. The other thing that you might notice, which happened to me, is that my blood pressure started to go up, and it didn't just gradually rise. It was sort of normal all my life. And my next doctor's appointment, which was just a well visit appointment, it was high. And in fact, because my doctor didn't know anything about it, I didn't know anything about it, and I'd always had normal to low pressure, we didn't even treat it because, oh, this must be an anomaly. Today, you rushed into the office, and this is just not really where you are. And there was not even any follow-up. It was sort of, we know that's not your normal blood pressure. You've been coming here for years. You always have low to normal blood pressure. You're probably stressed out today. We'll see you next year. And I went another year with high blood pressure, went to the office the next year, right? Because blood pressure is a silent killer. I'm feeling fine. That was just an anomaly. I didn't even think about it again. Never thought about it again. Off to my busy life. Next year. Think about this. Another year has gone by. I go in again just for my well check. Blood pressure still high. Oh, that's weird. It was high last year too. Hmm. Now we start to have a little bit of a conversation about it. But the prescription of antihypertensives is still sort of discussed as optional, because this is really strange for you. You've always had normal blood pressure. And so we start to have a talk of, are you doing this? Are you doing that? Are you having more sodium? No. Okay, let's keep an eye on it. Let's recheck it again, not in the office, maybe just go to a supermarket or something and check your blood pressure. So even I as a doctor had to deal with this because I didn't know anything about it. No one in my family talked with me about it, and I was a physician. Had never gotten any training in medical school or residency. As far as I knew, menopause was something maybe OB-GYNs managed. I really didn't know. It certainly wasn't cardiologists.
Dr. Jayne Morgan 12:33
And I had no idea that I should anticipate many different things, including rising blood pressure, because my blood pressure was always normal, never even occurred to me, and even when it was elevated, both my doctor and I decided it was just an anomaly. And so much of an anomaly, there was really no follow-up until the next year.
Katie Fogarty 12:54
It's such a common story, and it's amazing to hear that even as a medical professional, that you're still experiencing that what so many women experience, which is why these types of conversations, these types of education for women, is so important. Only you know your body as well as you do. So let's talk about some of the other silent signs of heart disease that women and medical professionals can miss or dismiss so that we know when these things pop up in our own lives, when we hear the women in our lives talking about these symptoms, we know to take them seriously. What are some other silent signs to be paying attention to?
Dr. Jayne Morgan 13:37
One of the more common symptoms that women have is fatigue. You can just be tired, more tired than usual, or small activities just seem to exhaust you, and you lay down and rest. Because women can think of a million reasons why we can be tired, because we're doing a million things for a million people. But fatigue actually can be one of the first symptoms. Sometimes flu-like symptoms, you just aren't feeling well, feels as if you're coming down with something. You never really come down with it, but you can't kind of shake those symptoms. Another common symptom, we unfortunately call these symptoms atypical, which is, I call it unfortunate, because that is actually a medical term, because it really drives action, or more accurately, it drives inaction when a woman presents to her physician's office or to the hospital, because these are called atypical symptoms, and it's sort of a wink and a nod to she's probably hysterical. In fact, sometimes we will even add rule out panic disorder, and it delays your care, and it means that it's one of the reasons why the first risk of a heart attack of a woman is more often fatal than a man. What else can we have? Sometimes we have back pain. Sometimes we can have pain in our right arm and not our left arm. Sometimes you can have jaw pain that might actually send you to the dentist for an oral exam. And the reason all of these things are going on and no alarm bells are going off in your head is because nobody has taught you, no one has taught anybody in your family, no one has taught society, even the physicians are a little bit blasé about it. And so we really are trying to raise this specter, but the symptoms of a heart attack of a woman may be different. You can certainly have these symptoms of chest pain, chest pressure, chest burning, shortness of breath, sweatiness, but you can also have this myriad of other symptoms that are a little bit more subtle and unfortunately, oftentimes, can be dismissed in women.
Katie Fogarty 15:00
Given the fact that some of these symptoms are so subtle and that mimic other common things like experiencing the flu or feeling run down, these are common experiences for women in our busy modern world, we're in the winter months where all of these sort of cold and flu season stuff feels so common, since these symptoms are somewhat subtle, are there specific tests or screenings that women in perimenopause and menopause should be going through with their doctor so that they can understand better if they are a high-risk candidate or if they're somebody who's not a risk candidate?
Dr. Jayne Morgan 15:47
Yeah, a couple of things. There is a risk calculator that can be used called PREVENT. It's one of our newer PREVENT risk calculators that a physician can use, or cardiologist as well. You can think about if you are asymptomatic, meaning you don't have symptoms, getting a calcium score. And you know one thing I'll say about a calcium score, this is a type of scan, like a CAT scan. And what I'll say about a calcium score is it is not a diagnostic tool, and it does not drive other tests. It is a risk predictor of your risk of heart disease or heart event in the next 10 years, and you're eligible to get a calcium score done, as long as you are asymptomatic, you don't have symptoms. If you have symptoms, then you really would bypass a calcium score. You would move on to direct cardiovascular workups for intervention. A calcium score is not for intervention and not for diagnostic workups. If you have symptoms, something else to test for, just labs, get your thyroid tested. Time to get your cholesterol tested, we want to make certain that your blood pressure is under control, meaning less than 120 over 80, and if that means taking medications, take medications. If your cholesterol is elevated and you are prescribed a statin, take the statin. Women are more often not prescribed statins, and our cholesterol levels are left elevated, and once we are prescribed, then we're less likely to take them. So there's not that encouragement, but I want to encourage you to take medications. Have good medication adherence, meaning that you are taking them regularly and as prescribed, such that you can get all of these metrics under control, because individually, they are risk factors for heart disease. Now during perimenopause, they may all be happening at once, and you want to make certain that they are under control. That includes even if you have to take medications. Oftentimes, people view taking medications as being sick. So I don't want to take medications because I'm not sick. I'm well, but you need to think of it this way. You need to take medications to prevent yourself from becoming sick later. That's how you should think about them.
Katie Fogarty 18:15
All great recommendations. When should a woman start to work with a cardiologist? Is it when they're experiencing symptoms? Is this something that you do once you know that you're in menopause? Is it something that you do if you have a family history, or is this something that every woman should consider?
Dr. Jayne Morgan 18:37
So if, certainly, if you have had any pregnancy complications like hypertension during your pregnancy, or preeclampsia or gestational diabetes, if you've heard any of these terms, eclampsia or even a small birth weight baby, and now you're in perimenopause, it is certainly a good time for you to check in with the cardiologist, because on top of perimenopause, you have a more accelerated risk of heart disease because of those complications that occurred during your pregnancy, and because you had those complications, it means that you have an increased risk of heart disease more than twofold a woman who does not have those complications. And I want to be clear, the pregnancy did not cause the complication, so I don't want you to think, oh my gosh, I can't get pregnant because if I develop any of these things, my risk of heart disease will go up. No, no, no, no, no. The pregnancy did not cause them. The pregnancy simply unmasked which women are at greater risk of heart disease. Because pregnancy is a volume overload state from a cardiologist lens. We call pregnancy volume overload state, not necessarily a pregnancy. And then if you develop any of these diagnoses, it really just means that you weren't able to handle that extra volume. So that's like a stress test that you have failed. So again, the pregnancy doesn't cause it. The pregnancy actually unmasked it for you, and now you know that you're at increased risk. So then, if you're going on into perimenopause and you still haven't seen a physician, let's say, after those pregnancy complications, it's certainly time for you to see a cardiologist.
Dr. Jayne Morgan 20:00
For women who've had no pregnancy complications, you don't have a family history, you're not necessarily even symptomatic, now in perimenopause, you could probably start with your primary care physician, your OB-GYN, and get the table of labs done. Make certain your blood pressure is under control, your cholesterol, your thyroid level, your iron stores, your ferritin level, all of those kinds of things to make certain you're nice and tuned up and it's a good time to move. You need to move more. Get a lot more movement, and add resistance to your movement. My favorite form of resistance is Pilates, but you can do resistance anything, carrying heavy boxes. You don't necessarily have to be in the gym, lifting weights, so something that creates resistance such that your bones are staying strong, and you're keeping muscle mass as well.
Katie Fogarty 21:00
Dr. Morgan, thank you so much for bringing up the complications during pregnancy. The first time on A Certain Age podcast when we looked into heart health, I was lucky enough to feature cardiologist Dr. Suzanne Steinbaum on the show, she mentioned the link between pregnancy complications like preeclampsia and future heart health impacts. I have three kids. I had preeclampsia with two pregnancies. It was that conversation that brought me into a cardiologist where I did a cardiac calcium score, and I will share with all listeners, it is a very easy, simple test. I felt a little bit of anxiety going into it, because I wanted a good result, and I got one, and I will share that when we do these midlife musts, you know, when we do the cardiac calcium score and we do our colonoscopies and we do our mammograms and all the things that no one looks forward to, you are either going to get information that you can act on to better improve your health, or you're going to get some peace of mind, which is what happened for me. So I'm really grateful that you brought that up.
Katie Fogarty 22:24
Again, I love this notion also of resistance training and Pilates as a lifestyle measure. As a cardiologist, what is it that you want to see women doing? What kind of agency do we have over improving our heart health with our lifestyle choices?
Dr. Jayne Morgan 22:35
And so movement is one big one. Women, I call it the one hour. Women tend to, not tend to, I guess I will say in survey after survey, we compare men and women, equal ages, equal family dynamics, meaning number of children, full-time job. Women get about one hour per day less of exercise and time to themselves than men do. And movement is one of the keys to keeping your body healthy, keeping the engine running. And we generally do not have as much opportunity as men have to focus that one hour on ourselves because of all of the family care responsibilities and how society expects us to take care of others and put others before ourselves, and we expected of ourselves as well. But here's the caveat to that, that women actually experience a more exaggerated benefit from the same level of exercise in the same time as men, and yet we get less. So we actually could derive more benefit from the same level of exercise as men, and instead, we oftentimes don't move at all because we're so busy managing everything else. And especially if a woman like you and I have full-time jobs, it becomes almost impossible because those child care responsibilities are still expected of the woman, and the woman also expects it of herself. And most women really do want families. They also want a career. And this sort of notion of can we have it all is starting to crumble a bit. It's starting to fray at the edges. So we see that stress and what that means when we look at who gets an hour per day to themselves and who doesn't.
Katie Fogarty 25:00
Yeah, when we think about it as 60 minutes, we would gift that to our children in a heartbeat, right? If it meant good health. And we need to take that on for ourselves, and that's something. This is exactly why we're having conversations like this all month long, because we want to give women tools to be strong, vibrant, healthy in 2026. So Dr. Morgan, if a woman shows up in a hospital, I know the data shows that they're more likely to have a fatal impact, or it'll take longer to get care, longer to get diagnosis. What are your recommendations as a professional for showing up, communicating to a medical care team what's going on, for being like a strong patient advocate for oneself?
Dr. Jayne Morgan 25:48
So if you are in the hospital and you're having sort of these vague symptoms, I'm calling them vague, really, you know, it's a little bit of a rub for me, because women are the majority of the population, almost 52%. How did our symptoms get to be atypical? How did our symptoms get to be the vague symptoms? How are we justifying what's happening when we are the majority? But that's the patriarchal health system, and so we find ourselves trying to advocate for symptoms that are occurring in the majority of the population. So that's the irony there. So there's sort of my rub on that.
Dr. Jayne Morgan 26:27
But if you were there in that situation, and there's no one with you to advocate for you, and it can be a daunting and intimidating environment, and obviously you're not feeling well, it's hard to advocate for yourself. Hopefully, the doctors are taking you seriously. We certainly have tried to work to educate cardiologists and emergency room physicians, but we know we still have not reached every single corner of the healthcare system. We are still working against this. So if you think you are being dismissed, if you are being discharged, if you're being delayed, the three Ds, right, dismissed, discharged, or delayed. If any of those things are happening, you should ask the ER physician, nurse, whoever is attending to you medically for an EKG. Now you're speaking the language of the system. And you may be somewhere where it's called an ECG, electrocardiogram, ECG, EKG. They're exactly the same thing. Now you're speaking the language of the system. You've just alerted the, say physician, in this case, that you're thinking about heart disease. Now she or he can think, ah, should I be thinking about heart disease, even if they're not thinking about it, just because you've asked, that gives an objective piece of information, hopefully, that someone can look at and derive some other kind of conclusion about you. So always ask for an EKG if it has not been done.
Katie Fogarty 27:49
Yeah. Fantastic advice. What would you say to a woman who's not even getting herself to the hospital? I have a dear friend whose mother was very reluctant to go to the hospital, even though they finally dragged her there over the holidays and she had had a heart attack, but they couldn't even get her in the door. And when they finally did, they discovered this. What would you say to a woman who's sort of second-guessing or overlooking her own symptoms? How do you encourage her to really put herself first?
Dr. Jayne Morgan 28:30
It is so hard. But think about this, ladies out there, in general, there's an average of a 37-minute delay in a woman getting care in comparison to a man. And you may say that's not really a long time. That's not even an hour, but when we're talking about heart disease and heart injury, for every five minutes of a delay in opening a vessel and reperfusing your heart, it increases your risk of death, and that is why the first heart attack of a woman is more often fatal than that of a man, because of this 37-minute delay. And 37 minutes means that there are outliers on either side. There are people who are waiting two weeks. Why? Because they're just feeling tired. They're feeling run down. They think it's something they've done. They think it's something they've eaten, etc., etc. They think it's something they've caught, some kind of virus, and they just don't really recognize those symptoms.
Dr. Jayne Morgan 29:19
And more often than not, you can see a woman in an emergency room for an initial evaluation and get an EKG and find out that she's had a heart attack in the past. And when you come and talk to her to say, hey, Mrs. Jones, I see that you've had a heart attack on your EKG. When was that? You didn't mention that in your history. She's shocked. No idea she's had a heart attack before. So women do stay home and actually have heart attacks. That's why the first heart attack is more often fatal. Those 37 minutes are critical. Minutes, every five minutes increases your risk of death.
Katie Fogarty 30:00
That is such a powerful number, and it's one I'll think about. This entire conversation has been almost 37 minutes. It's an enormous amount of time. You've given us so much great information. We want to be using that information to make sure that we're not having these delays. We need to be sharing this information with the women in our lives. Women are the greatest sources of information to one another, and we need to make sure that this information is front and center to keep us all healthy in 2026. Dr. Morgan, I so appreciate your time. Before I say goodbye, though, where can our listeners find you, follow you, and learn more about your heart health information?
Dr. Jayne Morgan 30:49
Yeah, listen, you can follow me on Instagram at Dr. Jayne Morgan, D-R, and then Jayne has a Y in it, J-A-Y-N-E, Dr. Jayne Morgan, all one word. I'm on Instagram, I'm on Threads, I'm on TikTok, YouTube, and I'm also on LinkedIn, Jayne Morgan, MD. So you can find me on most of those social media pages and follow along. I almost talk exclusively about heart health, women's health, midlife, and sometimes kind of throw in some other things. But follow along, send in your questions, and I'm happy to answer them. On Wednesdays, which is today, I do something called the Stairwell Chronicles, where I literally sit on my stairs in my house, in my clothes, and sort of give a little bit of advice in about 60 seconds, health advice, just little health tips to help you live a healthier life. Today, I talked a little bit about the importance of vitamin D to heart health in women.
Katie Fogarty 31:49
I love it. I love it. I love it. So much great information. I enjoy following you on Instagram. I've taken so much away from it, and I really appreciate your time today. Thank you for being with me, Dr. Morgan.
Dr. Jayne Morgan 32:05
Oh, thanks so much, Katie.
Katie Fogarty 32:07
This wraps A Certain Age, a show for women who are aging without apology. I am so appreciative that Dr. Morgan joined us today to share all of this critical information on heart health, heart attacks, how to figure out how to take care of your heart health for the long haul. I really appreciate her candor, how she shared her own high blood pressure journey, how even a doctor sometimes has difficulty getting to the root of what is going on with her changing body in menopause. This is such vital information. I'm going to ask you to share this with the women in your life whose heart health you care about. This stuff is too important, too good not to share. Thanks for sticking around to the end of the show. If you learned something, if you took something away from it, I would love to hear about it in the Apple podcast or Spotify review, because that's how other women find the show. And as always, special thanks to Michael Mancini, who composed and produced our theme music. Thanks for sticking around. See you next time, and until then, age boldly, beauties.