Am I having a hot flash or a heart attack?!

You’re lying in bed, your heart starts racing, and you swear you feel it skip a beat. Suddenly, you feel dizzy and a cold sweat breaks out across your forehead. Is this a hot flash, or the beginning of a heart attack?

If you’ve felt this way, you’re not alone. Heart disease is the number one killer of post-menopausal women, and the symptoms of menopause and heart attack can be startlingly similar. Dr. Eileen Hsich, Director of Women’s Heart Failure Center, Heart & Vascular Institute, Cleveland Clinic, explains how to tell the difference between your heart and your hormones.

  • What common symptoms of menopause are similar to those of a heart attack?
    • Symptoms of menopause include fatigue, racing heart, palpitations, headaches and hot/cold flashes. When it comes to a heart attack, men may feel a crushing pain in their chests, but women often feel less obvious sensations such as unusual fatigue, sweating, indigestion, irregular heartbeat, dizziness, nausea and weakness. Very similar to menopause symptoms.
  • What are some heart attack symptoms that are definitely NOT just menopause?
    • Chest discomfort–including a burning sensation that may be mistaken for heartburn–pain spreading to the shoulders, arm or neck, and “unusual” feeling or mild discomfort in the back of the chest, arm, neck or jaw, shortness of breath and discomfort or pain between shoulder blades.
  • Why is there this overlap? Does menopause affect your heart?
    • Premature menopause, without treatment, is a risk factor for earlier heart disease. However the main reason for this overlap is that cardiac symptoms in women, such as fatigue, can be so subtle. Also, heart palpitations can occur during hot flashes, so many women assume their palpitations are “just menopause” and don’t get them checked out. Palpitations should always get cardiac evaluation.
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  • So how do you know if what you are experiencing is a heart attack or something less severe?
    • Any chest symptom or any symptom in the chest arm or neck that is exertion related, or any reduction in exercise tolerance needs to be evaluated by a doctor. Also, know your numbers. It’s crucial to be aware of any risk factors you may have for developing heart disease. Understanding this information will help you determine if your symptoms are a warning sign for a heart event.
    • Cholesterol: Your total cholesterol should be less than 200 mg. Your LDL, or bad cholesterol, should be less than 130 and preferably under 100. Too much LDL in the blood can lead to cholesterol build-up and blockage in the arteries. HDL, or good cholesterol, helps remove cholesterol from the blood. The higher your HDL level, the better! For women, it should be higher than 55.
    • Blood Pressure: Blood pressure is a measurement of the pressure inside the arteries with each heartbeat. High blood pressure increases the workload of the heart and kidneys, increasing the risk of heart attack. Optimal blood pressure is 120/80 or less.
    • Glucose levels: Diabetes occurs when the body is unable to produce insulin or use the insulin it has. This results in elevated blood sugar levels. People with diabetes (especially women) have a higher risk of cardiovascular disease because diabetes increases other risk factors, such as high cholesterol, LDL and triglycerides; lower HDL; and high blood pressure. Keeping diabetes under control is essential to reducing your risk of heart disease.
    • Weight: The more you weigh, the harder your heart has to work to give your body nutrients. Excess weight also raises blood cholesterol, triglycerides and blood pressure, lowers HDL cholesterol and increases the risk of diabetes. People who carry their weight in the middle have a greater risk of developing cardiovascular disease, compared to people who carry their weight in their arms and legs. For women, waist circumference should be less than 35 inches.
  • Even if you know your numbers, what should you do if you start to experience heart palpitations, dizziness and sweating, assuming you’re also going through menopause? When should you ignore these symptoms, and when should you seek a doctor’s opinion?
    • Always pay attention to symptoms and see your doctor.
  • What sort of tests should you know to ask for if you’re concerned that your symptoms could be something more?
    • You may need an EKG, stress test, blood work and echocardiogram if you’re having symptoms.
  • Are there other symptoms that are often confused with a heart attack?
    • Heartburn is often mixed up in the diagnosis of a heart attack. You can not die from heartburn, but you can die from a heart attack, so always err on the side of caution and see a physician for evaluation of new or bothersome symptoms.
  • When should you definitely not worry?
    • After you’ve been thoroughly evaluated by your doctor.


This article is created in partnership with Speaking of Women’s Health, a national women’s health education program from the Cleveland Clinic Center for Specialized Women’s Health.

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Eileen Hsich, MDEileen Hsich, MD is the Director of Women’s Heart Failure Center, Heart & Vascular Institute, Cleveland Clinic