What Are the Signs of a Heart Attack in Women?

Heart attack symptoms vary between men and women because of key biological and physiological differences.

“A woman’s heart isn’t just a smaller version of a man’s heart,” says Dr. Grayver. “Our vessels are different, the caliber of our vessels is different, and the causes of a heart attack in a woman versus a man can also differ.”

“A cardiac angiogram might not show significant blockages in women, leading doctors to assume their symptoms are anxiety related rather than a serious cardiovascular event,” says Grayver.

There are also gender-based differences in heart structure, says Skyler St. Pierre, a Stanford University doctoral candidate who researches the mechanics of biological tissue in the Living Matter Lab in California.

Many women expect a heart attack to feel like a dramatic, chest-clutching event. But women’s heart attack symptoms can be much more subtle and easier to dismiss.

• Chest Pain or Discomfort Women often describe this sensation as tightness or pressure rather than a sharp, crushing pain.
• Pain in Other Areas Pain or discomfort can spread to the arms, shoulders, back, neck, jaw, or stomach.
• Shortness of Breath This symptom can occur even without chest pain.
• Heartburn, Nausea, or Vomiting It’s easy to mistake these signs for digestive issues.
• Lightheadedness or Dizziness These symptoms can be a sign that your heart isn't pumping blood effectively.
• Sweating A sudden and unexplained cold sweat can signal heart trouble.
• Unexplained Fatigue Feeling overwhelmingly tired, even without exertion, can also be a heart attack symptom for women.

“Women tend to recognize that something isn’t right, but they delay seeking care,” says Grayver. “Fewer than 44 percent of women even think heart attacks can affect them. They dismiss their symptoms, assuming they’re just tired or stressed.”

St. Pierre highlights the staggering difference in how healthcare professionals diagnose, and potentially dismiss, heart attacks in women compared with men.

“There is evidence that using sex-specific diagnostic criteria results in 30 percent more women and 4.9 percent more men being diagnosed with the same symptoms,” says St. Pierre. “Women tend to be diagnosed later than men, and once diagnosed, they have a higher mortality rate.”

“Going forward, I hope we will be learning about cardiovascular disease in women based on their reproductive years,” says Grayver. “We’ll study a woman’s heart health in her teens versus during reproductive years versus during post-reproductive years. These stages of life all affect your risk of cardiovascular disease differently.”

• Age and Family History “Your risk of a heart attack is especially higher if you have family members who’ve had sudden cardiac death or heart attacks or fatal arrhythmias, or if your father had a heart attack before age 55,” says Grayver.
• High Blood Pressure and High Cholesterol Both are key contributors to cardiovascular disease.
• Lifestyle Factors Smoking, obesity, and physical inactivity all play a role.
• Diabetes and Metabolic Syndromes These conditions disproportionately affect women’s cardiovascular health.
• Stress and Depression Women are more likely than men to experience stress-related heart complications.
• Pregnancy Complications Conditions like preeclampsia, intrauterine growth, preterm delivery, and gestational diabetes increase future cardiovascular risks.
• Autoimmune Diseases Inflammatory conditions like lupus and rheumatoid arthritis raise heart attack risk. “Women living with conditions like lupus are significantly more likely to have heart attacks, because the lining of the heart and the heart muscle itself is more inflamed,” says Grayver.
• Hormonal Changes Perimenopause and menopause can lead to metabolic syndrome and insulin resistance, increasing heart disease risk.
• Cancer History Treatments for cancer, such as chemotherapy and radiation, can increase a woman’s risk of heart attack because of how it damages the heart muscle, says Grayver.
• Polycystic Ovarian Syndrome (PCOS) This disorder increases your risk of metabolic syndrome, which increases the risk of heart disease.

• Regular Cardiovascular Health Screenings Annual checkups can detect warning signs early.
• A Heart-Healthy Diet Minimize sodium, saturated fats, and processed foods.
• Regular Physical Activity Aim for at least 150 minutes of moderate-intensity exercise per week.
• Quit Smoking Smoking is a major risk factor for heart disease.
• Stress Relief and Mental Health Meditate, practice yoga, or seek therapy to reduce stress-related heart health risks.

“One of the major reasons women are underdiagnosed and undertreated is the lack of sex-specific diagnostic criteria,” says St. Pierre. Many heart attacks in women present with symptoms like breathlessness, stomach or gut pain, or nausea, which aren’t common symptoms for men that most healthcare professionals are looking for. Therefore, women can easily be misdiagnosed or experience a delay in proper treatment because their symptoms are perceived as “atypical.”

If you or someone you know experiences symptoms of a heart attack, immediate action can save a life. Women should:

• Call 911. If you believe you may be experiencing a heart attack, don't hesitate to seek immediate help, even if your symptoms are mild or vague.
• Chew aspirin. If you’re not allergic, aspirin can help thin the blood and reduce clot formation.
• Stay calm and seated. Avoid unnecessary exertion while waiting for emergency care.
• Advocate for yourself. Clearly communicate your symptoms and insist on further testing if you feel dismissed.

“In cardiology, time equals muscle,” says Grayver. “The longer you wait, the more damage is done to your heart. Women often wait too long, and then the emergency room delays recognition of the heart attack, putting them at a significantly higher risk of mortality.”

Grayver adds that many women dismiss their symptoms and delay getting treatment.

“A lot of women think they’re just panicking, and then they tell themselves they don’t have time to go to the doctor because they have to get the kids to school, etc.,” says Grayver. “Even if your symptoms are atypical, you should call 911. Don’t simply schedule a doctor’s appointment for later in the week.”

Grayver also encourages women to start seeing a cardiologist once a year, starting in your twenties, especially if:

• You have a genetic predisposition (family history) of cardiovascular issues.
• You were born with any type of congenital anomalies, such as a ventricular septal defect.
• You’re considering pregnancy.

“More than 50 percent of women going into pregnancy aren’t at their optimal cardiovascular health,” says Gravyer. “And that’s very worrisome because it means they’re going into their thirties, forties, and fifties with suboptimal cardiovascular health.”

• Women experience heart attacks differently from men, often with subtle symptoms that can be mistaken for other conditions, including anxiety and digestive discomfort.
• Unique risk factors like pregnancy complications, autoimmune diseases, and menopause can increase a woman’s risk of experiencing a heart attack.
• Seek early screenings from your healthcare provider and adopt a heart-healthy lifestyle to reduce your risk of heart disease.
• Quick action when symptoms appear can save your life. Do not wait. Call 911 and get to an emergency room for immediate care.