Top Heart Attack Symptoms in Women
- Someone in the US dies from heart disease about every 37 seconds.
- But heart attack symptoms can be different in women compared to men.
- Women are less likely than men to get the proper cardiac evaluation when they report their symptoms.
- Knowing the symptoms, insisting your concerns are taken seriously, and getting a cardiac evaluation can save your life.
By Dr. John Neustadt
Someone in the US dies from heart disease about every 37 seconds, making it the number one killer of adults.1 Unfortunately, women are often at a disadvantage compared to men when it comes to getting the proper evaluation and treatment. One challenge is that the unique symptoms experienced by women aren’t recognized as heart-related. Women also tend to wait longer than men to get medical attention.2-4
But that’s only part of the story. Even when women report their symptoms to their healthcare, more than half the time they have their concerns dismissed as not related to their heart.5 As a result, women are less likely than men to get a proper workup. Knowing the symptoms, insisting your concerns are taken seriously, and getting a cardiac evaluation can save your life.
Early Warning Signs
Historically, a heart attack has been considered a ‘silent killer’ because it doesn’t show any symptoms in advance and kills without warning. But that’s not entirely true. As it turns out, symptoms of an impending heart attack can show up months in advance.
Symptoms can appear suddenly, can come and go, and can increase in intensity over hours, days, or weeks before the heart attack. Because many symptoms are not ones typically associated with heart disease, the general public and doctors have a harder time recognizing them as heart related. Additionally, women’s symptoms are frequently different from men’s. So if you’re simply waiting for the classic signs of gripping chest pain to prompt you to act, it may be too late.
In 2003 researchers looked at symptoms experienced by 515 women (average age 66 years old) who survived a heart attack. These women were all from the US and had been discharged from hospitals in Arkansas, North Carolina, and Ohio.6
In the months leading up to the heart attack, symptoms they hadn’t previously experienced started to show up. Most commonly, they included:
- Unusual fatigue (70% of the women)
- Sleep disturbances (48% of the women)
- Shortness of breath (42% of the women)
- Indigestion (39% of the women)
- Anxiety (35% of the women)
Surprisingly, the symptom most people associate with heart attacks—chest discomfort—was only experienced by 30% of the women before their heart attack.
Symptoms You’re Having a Heart Attack
Similarly, women can experience different symptoms than men when they’re having a heart attack. For example, according to the 2021 joint Clinical Practice Guidelines from the American College of Cardiology and the American Heart Association, women and men experience chest pain with the same frequency, but women are more likely to experience nausea and shortness of breath.7
In fact, many symptoms are more common in women than men. They include:8
- Back, neck, jaw, or arm pain
- Shortness of breath
- Shortness of breath that wakes you up and is usually relieved by sitting or standing up, called paroxysmal nocturnal dyspnea.
- Nausea and vomiting
- Lack of appetite
- Fainting or passing out
- Palpitations—having a fast-beating, fluttering, or pounding heart.
- A sense of dread
Recognize and React
Survival rates after a heart attack dramatically increase the quicker someone gets treatment. Unfortunately, studies indicate that women delay longer than men before seeking medical attention.9,10
Frequently symptoms women experience seem too mild for them to seek medical treatment because the symptoms don’t fit their pre-existing expectations.8 When doctors interviewed women whose symptoms evolved over time, the reasons why they didn’t seek help fell into two general categories. On the one hand, women didn’t recognize their symptoms as being serious.
One woman described her experience as, “It didn’t occur to me that it could be my heart. I took a couple of Tums thinking that’s going to take care of it, but it didn’t. I felt good for 10–15 minutes then it came back. Same thing, exactly in the same place, same severity, everything. It was strange, coming and going. Even when I was laying down or at the grocery store. It was off and on the entire day. It wouldn’t stay away long enough to forget it.”8
On the other hand, other women didn’t want to talk about their symptoms to someone else or seek medical help because “they weren’t bad enough to worry others.” One woman said, “I don’t like to complain about every little ache and pain. I want to make sure it’s ‘something’ before I tell him. If I complain, it’s ‘something’ because I don’t complain much.”
Of course, getting medical attention before you have a heart attack is always best. But if you do have one, the American Heart Association recommends seeking care within 5 minutes to increase your odds of survival. So don’t minimize what you’re experiencing, don’t delay asking for help, and make sure to advocate for yourself if your healthcare provider doesn’t take your concern seriously.
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1Heart Disease and Stroke Statistics – 2020 Update. American Heart Association. Accessed January 1, 2023.
2O’Donnell S, McKee G, Mooney M, et al. 2014;46(4):507-15.
3Davis LL, Mishel M, Moser DK, et al. 2013;42(6):428-35.
4O’Donnell S, Moser DK. 2012;27(4):334-44.
5Lichtman JH, Leifheit EC, Safdar B, et al. 2018;137(8):781-790.
6Charatan F. 2003;327(7424):1128-1128.
7Gulati M, Levy PD, Mukherjee D, et al. 2021;144(22):e368-e454.
8Davis LL. 2017;32(5):488-495.
9de Marvao A, Alexander D, Bucciarelli-Ducci C, et a. 2021;76 Suppl 4:118-130.
10Nguyen HL, Saczynski JS, Gore JM, et al. 2010;3(1):82-92.
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