Heart Attack Symptoms in Women: The Subtle Signs of Heart Attack

“There is an assumption that heart disease primarily impacts men,” says Dr. Sabeen Chaudry, cardiologist, Baystate Heart & Vascular Program, “but heart disease is the number one killer of women in the US, causing one third of female deaths every year. That’s really a startling statistic and it underlines why women need to be informed about what causes heart disease and be aware of their personal risk factors.”

The rates of heart disease are even higher in minority populations, affecting 40% of African American women and 30% of Latinas. Even more sobering is the fact that 1 out of 2 women of color in the U.S. will die of heart disease.

Many women may not be familiar with the specific, different signs of a heart attack in women. Movies and television depict heart attacks as starting with chest pain or pain in the left arm, primarily with men as the subject. But the symptoms of heart attack in women can be subtler, and may be missed if you don't know what to look for.

Symptoms of Heart Attack in Women

Despite the increased prevalence of heart disease, a study published in the May 2022 Journal of the American Heart Association found that women – especially racial and ethnic minorities – despite their increased risk of disease, are unaware of the signs of heart attack and stroke. Women may experience different heart attack symptoms than men. Because of this, treatment can be delayed because they don’t recognize the potential risk of cardiac disease or that they are experiencing a heart attack.

Some of the heart attack symptoms commonly experienced by both men and women include nausea or vomiting; squeezing chest pressure or pain; shortness of breath; heartburn; and jaw, neck and back pain.

Additional heart attack symptoms experienced by women include:

• Unusual or extreme fatigue
• Dizziness, fainting, or lightheadedness
• Weakness
• Strong feelings of anxiety
• Pain or pressure in the lower chest or upper abdomen

Chaudry emphasizes that, for women, a heart attack is not always accompanied by chest pain or chest discomfort. “Stay alert to these less obvious and lesser-known warning signs. And trust your gut. If something feels off, it probably is. If you’re experiencing unexplained symptoms, don’t dismiss them. You don’t need to have all the symptoms of a heart attack to have a life-altering heart attack.”

What Causes Heart Disease?

In addition to knowing the subtle symptoms of heart attack in women, it's helpful to understand what causes heart disease in the first place, what the risk factors are, and how you can reduce your risk and protect your heart.

Heart disease is caused by plaque buildup in the walls of the heart, arteries, and other vessels that supply blood to the heart and other parts of the body. This buildup can contribute to a number of disorders including heart attacks, strokes, blood clots, abnormal heart rhythm, and congestive heart failure. Where the buildup occurs determines what type of event is likely to occur.

“When we’re young our blood vessels and arteries expand and contract easily allowing blood to move freely,” says Chaudry, “But as we age, our vessels lose their elasticity as plaque accumulates and hardens. That can lead to obstructions and heart attacks or, if the plaque breaks loose, strokes and clots.”

Heart Disease and Heart Attack Risk Factors

Most people are aware of the following—and most widely-promoted—risk factors for heart disease:

• High blood pressure
• High cholesterol
• Sedentary lifestyle
• Smoking
• Diabetes
• Obesity
• Family history

“Because these risk factors apply to both men and women, they tend to get a lot of attention,” says Chaudry, “However, there are a significant number of risk factors unique to women that also deserve attention.”

These uniquely female and lesser-known heart disease risk factors in women include:

• Excessive weight gain during pregnancy
• Gestational diabetes
• Preeclampsia
• Pre-term delivery
• Polycystic ovary syndrome
• Systemic inflammatory and autoimmune disorders (i.e. lupus and rheumatoid arthritis)
• Menopause

Also, women who smoke are especially at increased risk for premature atherosclerosis, which is when plaque builds up in the arteries of the heart or in other blood vessels. Social isolation and depression can also contribute to cardiovascular disease risk.

“The list of potential risk factors for women is considerably longer than it is for men,” says Chaudry. “As we go through our lives and have different life experiences, the risk factors can add up, putting women at much higher risk for heart disease."

Chaudry urges women of all ages to regularly speak to their doctor about their risk factors. If you’re concerned with the number of risk factors that apply to you, ask if you should be tested.

“There are several simple blood tests and other assessments that can determine if you’re at increased risk for heart disease,” she says. “Be proactive in pointing out what your concerns are and asking what can be done to determine your risk. Remember, one in three women who die, do so because of heart disease.”

Take Your Heart Health to Heart

In many cases heart disease is preventable—82% preventable through lifestyle changes and efforts to stay heart healthy, according to the National Institutes of Health.

Learn more about how to reduce your risk of heart disease or schedule an appointment with the Baystate Heart and Vascular Program by calling 413-794-CARE (2273).

As a cardiologist at Baystate Health who sees many female patients, Dr. Chaudry encourages women of all ages to speak with their primary care provider to learn their risk factors, to set strategies to change their lifestyle, and to decrease their risk of heart disease. As the American College of Cardiology suggests to women— “Be Your Own Heart Hero.”