Recognizing Heart Attack Symptoms in Women: Essential Info

Key Differences Between Heart Attack Symptoms in Men and Women

Chest pain is a common heart attack symptom in both men and women. However, women are more likely than men to have other symptoms that can appear unrelated to a heart attack (see below for more details).

Women may experience more subtle symptoms such as fatigue, weakness, indigestion, and sleep problems up to a month before a heart attack, which may be mistaken for colds, flu, or hormonal fluctuations.  

Other key differences are that heart attack symptoms are more likely to occur during rest or sleep in women and during physical activity in men. Also, emotional stress is more likely to trigger symptoms of a heart attack in women. Learn more about how stress can cause a heart attack.

Early Detection of Cardiovascular Disease in Women

Early detection of heart disease in women is essential to lower the risk of potentially fatal heart attacks. The Centers for Disease Control and Prevention (CDC) says:

• More than 60 million women in the United States are living with heart disease. Coronary heart disease is the most common cause of a heart attack. 

• Heart disease is a leading cause of death in women in the U.S. It is responsible for about 1 in every 5 deaths in females in the United States. 

• The lifetime risk of heart attack is higher in women compared to men with similar risk factors, such as smoking, obesity, high blood pressure, high blood sugar, high cholesterol, and additional risk factors.

• Women are more likely than men to have heart attacks at an older age. However, new research in women’s health and the cardiovascular system has shown that younger women, between 35 to 54 years old, are having more heart attacks. Also, young women are more likely to die from a heart attack compared to young men.

Recognizing Symptoms of Myocardial Infarction (Heart Attack) in Women

There are subtle differences in the symptoms and signs of heart attack in women and men. Heart attacks happen when there is a narrowing of arteries and blockage of blood flow to the heart muscle. This is called coronary heart disease and it is the main cause of a heart attack.

Common Heart Attack Symptoms in Women and Men

• Chest pain or discomfort (this can be a sharp, squeezing, spasm-like pain or a dull aching pain)

• Chest tightness 

• An uncomfortable pressure, squeezing, and fullness in the chest

• Pain that spreads to the jaw, teeth, neck, shoulder, arm, back, or upper abdomen

• Shortness of breath

• Tiredness

• Dizziness or lightheadedness

• Cold sweat

• Indigestion or heartburn

• Nausea

Symptoms of a Heart Attack More Common in Women

Many heart attacks involve discomfort or pain in the chest. In addition to this common symptom, women are more likely than men to have the following symptoms during a heart attack:

• Neck pain, jaw pain, shoulder pain, upper back pain, upper stomach pain, or pain in one or both arms

• Shortness of breath

• Fatigue or tiredness

• Dizziness or lightheadedness

• Sweating

• Nausea 

• Vomiting

• Heartburn or indigestion

What Are the Signs of a Heart Attack in Women?  

The unusual symptoms and signs of a heart attack in women listed above are nonspecific or vague. However, in women experiencing a heart attack these vague symptoms are sometimes more noticeable than the most common symptom of heart attack, which is chest discomfort.

What Are the Symptoms of a Pre-Heart Attack or Mini Heart Attack?  

A mini heart attack, also called a pre-heart attack or silent heart attack, occurs when there is reduced blood supply to the heart, which causes damage to the heart muscle. However, the person experiencing a pre-heart attack does not recognize they are having heart attack symptoms and does not seek emergency medical care. Experts estimate that anywhere from 20% to 50% of all heart attacks are silent heart attacks, meaning they happen with no significant symptoms. 

Angina (chest pain) is the most common warning sign of heart disease. Other subtle pre-heart attack symptoms (female or male) may include:

• A general feeling of unease or being unwell

• Unusual fatigue or weakness

• Shortness of breath, trouble breathing, or wheezing

• Sweating

• Nausea 

• Vomiting

• Lightheadedness or dizziness

• Mild chest discomfort

• Mild pain in the throat

• Upper body (arm or back) pain that feels like a pulled muscle

How Do I Know If I'm on the Verge of a Heart Attack?

If you feel pain in your chest or experience any of the symptoms of heart attack listed above, seek immediate medical care.

In addition to the typical symptoms of a heart attack, such as pain in the chest, neck, and jaw, women may experience very subtle signs up to a month before having a heart attack. Symptoms include dizziness, indigestion, fatigue, weakness, and sleep problems, which can be mistaken for common colds, flu, or hormonal fluctuations. 

Whenever you are feeling unwell with new symptoms that have no obvious cause, you should see your doctor for a timely work-up and intervention. This can enhance your outcome and increase your chances of surviving a heart attack.

Risk Factors Specific to Women

Differences in Anatomy and Types of Heart Disease

• Anatomical differences: Women have smaller heart chambers (ventricles that pump blood), smaller blood vessels, and fewer red blood cells to carry oxygen. These anatomic differences and other risk factors can lead to an increased risk of heart attacks in women compared to men.

• Nonobstructive coronary artery disease: Researchers have found women are more likely than men to have a heart attack even in the absence of a severe blockage.

• Coronary microvascular disease: Women are at an increased risk of developing blockages in smaller arteries (in addition to the main arteries supplying blood to the heart). 

Underlying Health Conditions and Family History

• Diabetes: Compared to men, women with diabetes are at a higher risk of developing heart disease. Diabetes also increases the risk of experiencing a silent heart attack by interfering with pain signals. 

• Other health conditions: Certain medical conditions only occur in women or are more common in women and are linked to a higher risk of heart disease or a cardiac event such as a heart attack. Examples include polycystic ovary syndrome (PCOS), certain inflammatory conditions, and autoimmune diseases like lupus and scleroderma.

• Family history: Women with a family history of early heart disease are at a greater risk of developing heart disease than men with a similar family history. 

Lifestyle Factors

• Smoking: Women who smoke are at a higher risk of heart attacks than men who smoke.

• Inactivity: Lack of physical activity may increase heart attack risk to a greater degree in women than men.

• Stress and anxiety: Emotional problems tend to have a greater effect on women’s hearts. 

Hormonal Factors and Pregnancy Complications

• Menopause: Falling estrogen levels in menopausal women increase the risk of developing coronary microvascular disease (heart disease affecting small blood vessels). Read about other symptoms of menopause.

• Pregnancy: High blood pressure (preeclampsia) and gestational diabetes (high blood glucose during pregnancy) can increase a woman’s long-term risk of developing these conditions, which are major risk factors for heart disease. 

Treatment for Heart Attacks and Heart Disease in Women vs Men

• Studies show that compared to men, women are less likely to be prescribed aspirin and statins (cholesterol-lowering drugs) to prevent heart attacks in the future, even though these drugs have equal benefits in both men and women. 

• Women are also less likely to receive coronary artery bypass grafting (CABG or heart bypass surgery). This could be because women are more likely to have heart disease affecting smaller blood vessels. 

• Women are less likely than men to receive cardiac rehabilitation. Cardiac rehab is proven to improve recovery and outcomes after heart attacks. 

Learn about the medications prescribed after a heart attack.

Prevention and Management  

Lifestyle Changes to Lower Heart Disease Risk

Making healthy lifestyle changes can lower the chances of developing heart disease and experiencing an acute myocardial infarction (heart attack). Here are some tips from the American Heart Institute and the National Heart, Lung, and Blood Institute on leading a heart-healthy lifestyle:

• Avoid smoking. Smoking causes damage to blood vessels and is a major risk factor for heart disease and heart attacks. If you smoke, talk to your healthcare provider about effective ways to help you quit.

• Eat a heart-healthy diet. Eat more fruits, vegetables, whole grains, lean proteins, no-fat or low-fat dairy, and healthy fats like olive oil. Avoid processed foods, salty snacks, food, and beverages with added sugar, and saturated fats and trans fats.

• Get regular exercise and maintain a healthy weight. If you're overweight or obese, losing just 5-10% of your body weight can lower your risk of heart disease and heart attack. Moderate exercise of 150 minutes each week and strength training twice a week can help you maintain a healthy weight.

• Get enough restful sleep. Experts recommend 7-9 hours of sleep daily for heart health and overall health.

• Manage mental health. Stress and anxiety are linked to tightening of the arteries and coronary microvascular disease. Exercise, yoga, tai-chi, mindfulness, progressive muscle relaxation, and deep breathing exercises are effective ways to manage mental stress.

• Limit alcohol consumption. If you drink alcohol, limit yourself to no more than one drink a day (for women) or two drinks a day (for men).

Monitoring Heart Health at Home  

You can monitor heart health at home by measuring your weight and recording your blood pressure with a home blood pressure device. However, it is important to get regular health checkups and screening exams. This will help with the early detection of high blood pressure, high blood sugar, and high cholesterol, which are major risk factors for heart disease and heart attacks. 

Warning Signs: What to Do in Case of a Heart Attack?

Immediate Steps for a Suspected Heart Attack

A heart attack is a medical emergency. If you think you’re having a heart attack, take these immediate steps:

• Call 911 or your local emergency number or have someone drive you to the nearest emergency room. Drive yourself to the hospital only if there is no other option.

• Take nitroglycerin, if prescribed by a healthcare provider, while waiting for emergency medical personnel to arrive.

• Take aspirin, if recommended by a healthcare provider. This can help dissolve a blood clot and reduce damage to your heart. Do not take aspirin unless your doctor has told you to. Also, don’t delay calling 911 or wait to see if your symptoms improve after taking an aspirin. Call for emergency help before taking an aspirin. 

If you think someone else is having a heart attack, call 911 or emergency services. Then, check if the person has a pulse and is breathing. Begin cardiopulmonary resuscitation (CPR) if they aren’t breathing or you can’t find a pulse. Do hands-only CPR (chest compressions) if you are not trained in CPR. 

Note: A heart attack is different from heart failure, heart failure exacerbation, or acute heart failure. A heart attack occurs suddenly and is a medical emergency. Heart failure develops gradually when the heart is unable to pump blood efficiently. Symptoms of chronic heart failure are treated with long-term medical management.

Heart attacks can occur suddenly, sometimes without warning signs, whereas heart failure exacerbations typically worsen heart failure symptoms such as severe shortness of breath, sudden weight gain, and significant swelling. Exacerbations of heart failure are medical emergencies that, if left untreated, can result in life-threatening complications such as pulmonary edema.

A heart attack is also different from a cardiac arrest. A cardiac arrest occurs when the heart suddenly stops beating due to a problem with the heart’s electrical activity. An automated external defibrillator (AED), if available, can be used to revive the heart of a person experiencing a cardiac arrest. A person having a heart attack will often be conscious and breathing, and an AED is not needed to restart the heart in this case.

Read more about the difference between cardiac arrest and a heart attack.

Seeking Medical Help: How Can I Rule Out A Heart Attack At Home?

You cannot rule out a heart attack at home. It is a medical emergency and needs to be treated in a hospital. Seek immediate medical care for any signs or symptoms of a heart attack. Chest squeezing, fullness, or pain is the most common symptom of a heart attack.