Heart Attack Symptoms in Women: The Signs That Get Missed

If you think you or someone else may be having a heart attack, call your local emergency number now. Do not drive yourself or wait for an online answer. The symptoms do not need to be dramatic before they deserve emergency attention.

Why do women experience heart attacks differently from men, and why do they tend to happen later in life?

For decades, the typical image of a heart attack has been a man suddenly clutching his chest in severe pain. But heart attacks do not always follow this pattern, especially in women. Women may experience chest pressure, but they can also develop nausea, breathlessness, unusual fatigue, or pain in the back, neck, or jaw. These symptoms are sometimes mistaken for digestive problems, stress, or exhaustion.

Importantly, chest pain remains the most common heart attack symptom in both women and men. The difference is that women are more likely to experience several additional symptoms, sometimes without prominent chest pain.

1. What symptoms are more common in women?

• Chest discomfort: Pressure, tightness, squeezing, burning, or heaviness rather than necessarily sharp pain.
• Upper back, shoulder, neck, or jaw pain: Sometimes occurring without obvious chest discomfort.
• Shortness of breath: Even at rest or with minimal physical activity.
• Nausea, vomiting, or indigestion: Symptoms that can resemble gastrointestinal illness.
• Unusual fatigue or weakness: Particularly when sudden, unexplained, or accompanied by other symptoms.
• Cold sweating, dizziness, or lightheadedness: Especially when occurring together with other warning signs.

A systematic review of 27 studies also found that, compared with men presenting with acute coronary syndromes, women had approximately:

• 2.15 times the odds of pain between the shoulder blades.
• 1.64 times the odds of nausea or vomiting.
• 1.34 times the odds of shortness of breath.

These are relative differences, not the probability that a particular symptom means someone is having a heart attack.

Why recognition can be delayed

An upset stomach can sound like something you ate. Breathlessness may be blamed on stress. An unfamiliar ache can seem like a pulled muscle. Sometimes those explanations are correct; guessing is the problem when a serious cause remains possible.

The US National Heart, Lung, and Blood Institute notes that women may downplay symptoms and delay treatment. Some women also have heart attacks that are harder to identify with usual initial assessments. That is a reason to take persistent concern seriously and describe it clearly.

You do not need to decide whether your symptoms are sufficiently “typical”. Tell the emergency dispatcher what is happening, where you are and when it started. Follow their instructions.

Do not wait for every sign

Symptoms can develop gradually, feel mild at first or come and go. A previous heart attack may also feel different from a later one. The absence of one expected symptom does not settle the question.

If you are with someone who may be having a heart attack, stay with them and help make the emergency call. Do not delay it to find a medical record, pack a bag or arrange ordinary transport. An ambulance team can begin assessment and treatment on the way to hospital.

Say what you are worried about

It can help to use plain, direct language: “This chest pressure is new, I am short of breath and I am worried about my heart.” Give the timing and describe any other symptoms. Mention relevant conditions and medicines if you can do so without delaying help.

If you have already been assessed but symptoms persist, return or worsen, seek medical help again. Explain what has changed. You do not have to make your account sound more dramatic; a clear description is useful.

Save this information when you feel well. If an emergency happens, the useful action is the call for help, not another search for reassurance.

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Author:

Oleksandra Telehuzova

Chief Medical Officer, MD