Heart attack signs in women may differ

Here’s what you need to know

What causes a heart attack in women? Pretty much the same things that cause a heart attack in men. Smoking, high cholesterol levels, high blood pressure, inactivity, excess weight, diabetes, and a family history top the list.1 But what signals that a woman may be having a heart attack can be quite different.

Signs and symptoms

Women are more likely than men to describe their chest pain as sharp and burning, and they more frequently report nausea, fatigue, or difficulty breathing, dizziness, or jaw, neck, or upper body pain.2

What’s more, a woman’s symptoms are more likely to be triggered by stress and less likely to be triggered by exertion.3 “I was going through a lot of stress at the time of my heart attack,” says heart attack survivor Sue Chlebek, 58, of La Porte, Indiana.  “It’s something I still struggle with. I can control what I put in my mouth and how often I exercise. Controlling stress is harder.”

Not just a man’s disease

Then there’s the notion that only men have to worry about heart disease. “Many women think that it’s a man’s disease and that it can’t happen to them,” says Mary Ann Bauman, an Oklahoma City internist and the American Heart Association’s 2012 Physician of the Year. So they may ignore the risk. “Women are far more likely to bug their husbands about getting to the doctor than they are to do the same for themselves,” notes Bauman.

“If you ask, the majority of women will say breast cancer is their major risk for a fatal disease,” she adds. “And 40,000 American women do die of breast cancer each year, which is terrible.” But by age 55, heart disease deaths surpass breast cancer deaths, and after age 75, heart disease kills eight times more women than breast cancer.

“I thought breast cancer was my greatest risk,” says Sue Chlebek. “Every year I’d have my mammogram and my pap smear. I always thought, ‘Oh, heart disease. When I’m 70 or 80, it may be a risk for me.’ But not when I had barely turned 50, with a six-year-old.”

Diagnosing heart disease in women

It can be difficult for physicians to tell that a woman has heart disease, notes Bauman. “That’s because the disease may develop differently in women, and the common diagnostic tests are more accurate in men.”

Men are more likely to have obstructive coronary artery disease, where a blood vessel that brings oxygen to the heart muscle gets blocked, says Bauman. Those kinds of blockages can readily be seen on an angiogram, which tracks blood flow with an X-ray and a dye injected into the bloodstream.3

But in women, heart disease is more likely to occur in the tiny blood vessels, which may be no wider than a human hair.4 The problem isn’t that plaque blocks the tiny vessels, but that their inner walls become damaged. The damage can cause spasms and cut off blood flow to the heart muscle. That’s a heart attack.

“Our blood vessels are more than just pipes that blood flows through,” Bauman explains. “They’re actually organs that expand and contract in response to the need for blood flow.”

The type of heart disease that’s more common in women, called small artery disease or coronary microvascular disease, can’t easily be detected with the usual tests—an angiogram or cardiac catheterization—that work well in men.5 “So other tests, such as a stress test, may be necessary to make the diagnosis in women,” says Bauman.

Her bottom line: “Most heart disease is preventable if you pay attention to the risk factors. You can’t change your family history, but you certainly can exercise, lose weight, and eat better.”


1 www.nhlbi.nih.gov/health/health-topics/topics/hd.
2 www.nhlbi.nih.gov/health/health-topics/topics/hdw/signs.
3 Circulation 130: 350, 2014.
4 J. Am. Coll. Cardiol. 47: S21, 2006.
5 Am. J. Manag. Care 7: 95, 2001.

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