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Heart Attack Symptoms in Women—Why Signs, Diagnosis, and Treatment Differ From Men

Medically Reviewed by

While men are twice as likely to suffer a heart attack as their female counterparts, women are less likely to survive their first myocardial infarction, (as it is technically known) according to recently published research in the Journal of the American Medical Association, Internal Medicine. And women often experience different symptoms than those of men, which can sometimes be misinterpreted or misunderstood—even by physicians.[6][2]

Heart Attack Symptoms in Women—Not the Same for Men

Classic symptoms such as extreme tightness, and pressure or pain in the chest may not always be present in women suffering from a heart attack, according to the American Heart Association, and NYU’s, Langone Medical Center.

Women may instead experience the following:

  • Shortness of breath
  • Pressure or pain in the lower chest
  • Upper abdomen pressure or pain
  • Dizziness
  • Lightheadedness
  • Fainting
  • Lack of appetite
  • Upper back pressure
  • Extreme fatigue
  • Pressure, squeezing, fullness, pain, in the center of chest
  • Pain in arm, back, neck, jaw
  • Upset stomach
  • Pressure, fullness, squeezing, or pain that either lasts, or is intermittent in the center of the chest
  • Cold sweat
  • Nausea
  • Vomiting[3]

Signs of a Heart Attack in Women—May Be Subtle or Go Unrecognized

While heart disease remains the number one killer for women in the United States, women often put down many of the telltale signs of heart attack to normal symptoms of aging, weight gain, acid reflux or stress, rather than associate them with heart disease or the possibility of a heart attack. Because they may be scared, and tend to put their families first, it’s sometimes easier for women to ignore subtler signs of heart distress or deny they exist at all.

Heart Attack Signs for Women, Chest Pain in Women Still #1 Symptom

Despite other less obvious signs, chest pain in women is still the major symptom many experience, before or during a heart attack, indicating serious distress with blood flow to the heart.[3]

Women Heart Attack Symptoms—More Gradual Blockage

Heart disease in women actually manifests differently than in men. This may be the reason so many signs of a heart attack in women go misinterpreted, even by healthcare providers themselves. Obvious blockages in large arteries, detected by standard angiogram tests, many times don’t exist. Instead, plaque spreads out evenly along artery walls, or builds up in smaller arteries, causing blood flow to the heart to gradually decrease. The medical term for this condition, “microvascular syndrome” creates the subtler symptoms such as, shortness of breath, or jaw pain, as blood flow becomes dangerously low. Women can continue becoming sicker and sicker, as the stage for heart attack is set, sometimes even 5 years before the actual event.[4]

Heart Attack Symptoms for Women, Unique and Gender Specific

These may occur:

  • While at rest or asleep.
  • When women are mentally stressed.
  • As many as ten years later than those of a man.[8][1]
  • Without warning. Women may seek emergency medical attention after serious damage due to a heart attack, has already occurred.

Heart Attack Women, Coronary Risk Factors

Several medical factors have been found to increase the risk of heart attack for women in particular.

These include:

Blood Lipids—High triglycerides and Low HDL increase the risk of heart disease death in women over 65.

Diabetes—This disease increases the risk for a first heart attack in women more than it does in men, and doubles heart attack risk for a second attack in women as well.

Metabolic syndrome—High triglycerides, high blood pressure, glucose intolerance, low HDL cholesterol, and a large waistline are all part of metabolic syndrome. This increases the risk of heart attack for women at an earlier age, and of death within eight years, over men with the same syndrome.

Smoking—Female smokers are more likely to suffer a heart attack than male smokers.[5]

Signs of a Heart Attack for Women in Distress

During a heart attack, female symptoms are experienced to varying degrees including:

  • Shortness of breath (58%)
  • Weakness (55%)
  • Unusual fatigue (43%)
  • Cold sweat (39%)
  • Dizziness (39%)
  • Nausea (36%)
  • Arms weak/heavy (35%)[5]

Signs of Heart Attack For Women are different than those that occur in the months leading up to the actual cardiac event.

Signs of Heart Attack Women May Ignore

One month before a heart attack, some percentage of women experience these signs:

  • Unusual fatigue (71%)
  • Sleep disturbance (48%)
  • Shortness of breath (42%)
  • Indigestion (39%)
  • Anxiety (36%)
  • Heart racing (27%)
  • Arms weak/heavy (25%)[5]

Women and Heart Attacks—Why They May Be More Deadly

More women than men die within a year of having a heart attack. Here’s Why.

  • Women are usually older than men when they have heart attacks.
  • Women generally are not as responsive to treatments administered during or after a heart attack as their male counterparts.
  • Many women experience a heart attack more like an odd discomfort in the back, or some other symptom, easy to dismiss, unlike intense chest pain.

Why Symptoms of Female Heart Attack May Be Dismissed

  • Healthcare providers are trained to look for a specific set of symptoms associated with heart attacks in general. When women do go to the hospital, professionals may fail to properly diagnose a heart attack, if symptoms are not clear. Without a specific diagnosis, a woman may be released, and left to believe that nothing serious is occurring.
  • Even if a heart attack (or blockage in the arteries) is suspected, standard imaging may fail to detect the damage or obstruction.[4]

Female Heart Attack Symptoms—Diagnosis and Treatment

Many women report receiving little, if any, information from their physician regarding coronary risk, and heart attack. Some doctors even mistake signs for minor discomfort such as indigestion. Others may also suggest a diagnosis such as, panic disorder, or even hypochondria. Women often don’t reflect accurate results on standard stress tests and angiograms either.

Regarding treatment, clot-busting drugs that work well for men don’t appear to be nearly as effective for women, and because women have smaller coronary arteries than men, angioplasty and coronary bypass surgery can be more difficult to perform as well. Women also suffer more complications after surgery, and live with symptoms many times, years after coronary angioplasty procedures.[5]

Heart Attacks in Women May Be Reduced Significantly

Reduce heart disease and heart attacks by making simple changes. There are many lifestyle decisions women can make to help reduce the risk of heart attack including:

  • Eat a healthy diet complete with fruits, vegetables, whole grains and low fat dairy products. Keep saturated fats, salt, cholesterol, and sugar to a minimum.
  • Get at least 21/2 hours of exercise each week.
  • Refrain from smoking.
  • Limit alcohol intake. Women should consume no more than one drink per day.
  • Know the health history of your family and any genetic risks for heart disease or conditions.
  • Effectively manage other medical conditions that may affect heart health such as diabetes, obesity, or high cholesterol.[7]

While both men and women are at risk for heart attack, and heart disease that causes many myocardial infarctions, women are much more likely to suffer symptoms in silence. Without proper diagnosis and treatment, women may live years with many of the precursors to heart attack, without ever even knowing. Lifestyle choices, coronary heart disease education, and regular physician’s visits are all critical for heart health in women as they age.


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