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Can Early Warning Symptoms Predict a Heart Attack?

Three older women smiling on a hike
Three older women smiling on a hike
Carolyn Thomas

Carolyn Thomas

Author, Public Speaker, & Activist

Did you know that the majority of heart attack survivors report knowing something was very wrong” in the days, weeks, or even months leading up to their ultimate cardiac event?1

I would have answered “no” to that question, but that was before I experienced my own weird symptoms of extreme shortness of breath while walking to work two days in a row the week before my heart attack. But like most cardiac patients, I dismissed those symptoms because they went away on their own.

I also didn’t know at the time that, especially in women, cardiac symptoms can come and go — and come back again. No wonder I ignored them.

We now know that what doctors call prodromal early warning signs can actually indicate that the heart is in trouble.

Dr. Sheila O’Keefe-McCarthy is a cardiac researcher and professor at Brock University whose studies have found that female heart patients experience more of these early prodromal symptoms than males do.

In her research, she found that women with one or more prodromal symptoms were four times more likely to have a subsequent major adverse cardiac event compared with women who hadn’t experienced those symptoms in advance.2

The most commonly reported prodromal symptoms are:

  • Crushing fatigue: 100%
  • Anxiety: 100%
  • Arm pain/discomfort: 86%
  • Shortness of breath: 86%
  • Nausea, vomiting, indigestion: 71%

Dr. O’Keefe-McCarthy (whose mother, sister, and father-in-law had each died of heart disease after unusual prodromal symptoms that had been ignored) explained that this research is helping to raise awareness of these warning signs.

You know your body, and you know when something just isn’t right.

But how can we tell the difference between an actual prodromal symptom and something that’s just one of many benign sensations our bodies may produce on any given day?

The critically important difference: it’s when these symptoms feel highly unusual that you need to take particular notice. And “unusual doesn’t mean unbearable or even painful ­­— just distinctly unusual for you.

You know your body, and you know when something just isn’t right. And as Dr. O’Keefe-McCarthy explains, a lack of knowledge about issues like prodromal warning symptoms can result in delays in seeking urgent medical attention. Certain groups of women, she adds, are particularly at risk.

“Women who are older, experiencing menopause, living with other existing conditions such as hypertension or diabetes, or presenting with inexplicable symptoms like increasing fatigue or breathlessness are stuck in a cloud when it comes to diagnosis,” she says. “But cardiac early warning signs don’t need to remain a mystery.”

She believes that early recognition of these prodromal symptoms is imperative for effective targeting, screening, diagnosis, and timely treatment to identify those at risk for future heart disease-related events.

In other words, next time you present yourself to the emergency department with what you believe could be cardiac symptoms, don’t forget to mention to emergency staff if you’ve also noticed that any of your current symptoms happened earlier during the weeks or months prior to your visit.

Carolyn Thomas is an author, public speaker, women’s heart health activist, and the first Canadian ever accepted to attend the WomenHeart Science and Leadership patient advocacy training at the prestigious Mayo Clinic. This article is an excerpt from the original published on her blog, Heart Sisters. Carolyn is also the author of A Woman’s Guide to Living with Heart Disease (Johns Hopkins University Press, 2017). She lives on Canada’s beautiful west coast in Victoria.


  1. J.C.  McSweeney. “Women’s Early Warning Symptoms of Acute Myocardial Infarction”. Circulation; 108: 2619-2623 November 3, 203, 2003.
  2. S. O’Keefe-McCarthy S. and L. Ready, “Impact of Prodromal Symptoms on Future Adverse Cardiac-Related Events: A Systematic Review”. Journal of Cardiovascular Nursing. 2014
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