Reena Caprario ate a healthy diet, exercised almost every day, maintained a good weight and felt well while doing cardio, so she never worried about the possibility of a heart attack.
“Absolutely not. No way,” Caprario, who lives in Apopka, Florida, tells TODAY.com. “The thought didn’t cross my mind at all.”
Yet last year, at the age of 54, Caprario ended up in the emergency room with a heart attack after ignoring the warning signs for a week. Doctors discovered one of her coronary arteries was 99% blocked.
Crushing chest pain is a typical heart attack symptom and one of the heart warning signs never to ignore.
But Caprario didn’t experience that until the final stages of her crisis. Instead, she had mainly atypical warning signs, which tend to occur more in women than men, says Dr. Linus Wodi, her cardiologist at AdventHealth in Apopka.
“Unfortunately, when patients have those symptoms, they can attribute them to other things,” Wodi tells TODAY.com.
“So it might take a while before patients show up to the emergency room, which is unfortunate because the earlier you seek medical attention, the earlier you get taken care of.”
Heart disease and stroke claim more lives in the U.S. than all forms of cancer and chronic respiratory disease combined, according to the latest statistics from the American Heart Association.
Almost half of Americans, 48%, have some form of heart disease, with doctors calling it “common, catastrophic and costly,” in a perspective published in January in the journal Circulation.
Women have much higher risk of dying after a heart attack than men, studies have found. One of the possible reasons is that women frequently have atypical symptoms of a heart attack, researchers note.
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Subtle symptom grows into emergency
Caprario has some big risk factors for heart disease, including Type 2 diabetes and a family history — her father had a triple bypass in his 60s. She’s also a former smoker.
But she always ate healthy to manage her diabetes and was much more active than her father, doing cardio and walking 2 miles a day as part of her exercise routine, so she thought her heart was fine. At 5 feet, 1 inch tall, she had a healthy weight of 110 pounds.
In May 2024, Caprario noticed her left shoulder blade was hurting. She thought it was indigestion because when she’d previously experienced acid reflux, she felt it up by her shoulders.
The pain went away but returned a couple of days later, and this time, it hurt a little bit more and was no longer just in her back “but kind of coming through to my chest,” Caprario recalls.
As more days passed, the pain spread down her left arm and into her hand, and then to her left jaw and the left side of her head and mouth. Caprario calls it “excruciating pain.”
“I could tolerate my chest pain. I just couldn’t tolerate the pain in my teeth,” she says. “I almost felt like a throwing up from the pain.”
The back pain, jaw discomfort and hurting teeth can be atypical symptoms of a heart attack, Wodi says. People can dismiss them as a pulled muscle, toothache or indigestion.
Women tend to have more subtle heart attack warning signs than men, including:
- Nausea
- Lightheadedness
- Extreme fatigue
- Cold sweats
- Pain in the neck, arms or shoulders
- Chest palpitations
- Feelings of heartburn
Wodi says Caprario’s shoulder blade ache is an example of referred pain, or pain felt in a different part of the body from where the actual injury is. It happens because all the nerves in the body are part of a big, connected network, the Cleveland Clinic notes.
She had plaque buildup in the arteries, but never felt chest pain, even while exercising, because her heart was still getting adequate blood flow — until a plaque rupture, which caused a blood clot to form, blocking the artery to the heart, Wodi says.
“With a heart attack, the heart muscle is being starved of blood and oxygen. If you don’t restore that blood flow, then you have muscle damage,” he warns.
‘I was in denial’
A week after the onset of symptoms, Caprario finally alerted her primary care doctor, who did an EKG and sent her to the emergency room.
“I was in denial. I kept saying there’s no way I’m having a heart attack,” she recalls.
A blood test showed she had extremely high levels of troponin — a protein that’s part of the heart muscle and leaks into the bloodstream when the heart muscle is damaged. It confirmed Caprario had a heart attack, Wodi says.
Doctors opened her blocked artery with a balloon and placed a stent. She then took part in a 12-week cardiac rehab program.
Today, Caprario says she’s feeling well and continues to do cardio every weekday for 45 minutes on a treadmill, elliptical or stationary bike. She takes a medication to lower cholesterol.
She’s urging others to not wait as long as she did to get medical attention.
“Especially women, we tolerate pain a lot more than men. Our symptoms are different than men,” Caprario says.
The most important thing is to know your modifiable heart disease risk factors — like high blood pressure, high cholesterol, smoking, excess weight — and to control those risks, Wodi notes.
“We see patients who haven’t seen their primary care providers in years, and then they show up with a heart attack, so regular checkups with a primary care doctors tend to pick up those risk factors,” he says.
If you’re able to exercise, and then suddenly, you feel much more out of breath than before, that’s cause for concern, he notes. So is feeling overwhelmingly tired for no reason.
“Pay attention to your body. Listen to your body,” Wodi says.
Find out how cardiologists keep their own hearts healthy with eight daily habits, and six things a heart surgeon avoids for his own heart health.
