Women May Experience Subtle Heart Attack Symptoms

Karen Hill didn’t know she was having a heart attack. Here are the symptoms she misinterpreted.

Medically reviewed in January 2022

Updated on January 27, 2022

Karen Hill was sitting in church when the pain started. It started as a dull ache above her right breast and below her collarbone: a familiar pain that Hill had experienced several times before.

“I didn’t think I was having a heart attack,” says Hill, who lives in Ogden, Utah, about 30 minutes outside Salt Lake City. Her husband of 54 years had died a month earlier from colon cancer and her family was still numb.

“I brushed it off as stress,” she adds.

Radiating pain: a lesser-known heart attack symptom
As the pain advanced from dull to sharp, it radiated up into her neck.

Radiating pain might start in different places for different people, but it often means that you’re having a heart attack, says heart surgeon Joseph Graham, MD, who treated Hill at Ogden Regional Medical Center.

“That’s when I knew something was different,” says Hill, who was 71 at the time. “This pain was something new. It went up into my neck and it wasn’t going away. I thought, ‘This is not right. This pain is different.’”

Still, Hill believed she knew the signs of a heart attack—pressure in your chest, dizziness, nausea. She didn’t have those symptoms.

Heart disease is the leading cause of death in American women, killing about one woman every minute. But many still miss or misinterpret the signs. As with Hill, the absence of chest pain can be misleading.

It’s true that for women and men, chest pain is the most common heart attack symptom. Other symptoms that aren’t gender-specific include:

  • Pain, pressure, squeezing, or tightness in the center of the chest
  • Pain or discomfort in one or both arms, or in the back, neck, jaw, or stomach
  • Fatigue
  • Breaking out in a cold sweat
  • A sensation of indigestion or heartburn

Women, however, are more likely than men to experience certain different heart attack symptoms, such as:

  • Shortness of breath
  • Nausea or vomiting
  • Neck, back, arm, or jaw pain or discomfort, including upper-back pressure
  • Pressure or pain in the lower chest or upper belly
  • Dizziness, lightheadedness, or fainting

Why do women sometimes misinterpret heart attack signs?
For one thing, they might be more stoic.

“Women can tolerate pain much better than men can,” says Dr. Graham. “In my experience, a lot of times women will have a severe heart attack and ignore it.”

Other reasons that women might miss or ignore signs include:

  • Believing they could never have a heart attack.
  • Assuming it’s something else like acid reflux or the flu.
  • Being used to functioning while ill.

In addition, women may report these heart attack signs but still face misdiagnosis from healthcare providers (HCPs), according to the American Heart Association.

Hill ignored her pain and continued to sit through the hour-long church service. She then drove to her daughter’s house for dinner. Another hour passed and the pain continued. Her daughter’s neighbor happened to be a doctor and checked her out. He recommended she go to the hospital. Hill didn’t think that was necessary, though. She decided to lie down before returning home.

A risky night and a happy ending
But as the night wore on, the pain intensified. Finally, Hill headed to her local hospital. She drove herself there—which isn’t recommended because a delay in care could lead to permanent heart damage while worsening symptoms could lead to a traffic accident.

Hill also swallowed about 5 or 6 expired baby aspirin, which she was carrying based on a friend’s recommendation.

That may have saved her life, Graham notes, adding, “There’s been proven evidence that aspirin will unclog a clogged artery.”

Still, Hill risked her life by not calling 911. If you experience heart attack warning signs, dial 911 before you do anything else. Getting the ball rolling immediately could save your life. Do not take aspirin and wait for pain relief—aspirin is not enough to treat a heart attack, nor is it safe for everyone. The 911 operator may recommend aspirin or the emergency medical technicians or emergency department HCPs may give it to you, but the most important step is to call 911.

By the time Hill finally walked into the hospital, three hours had passed from when the pain first started. Tests showed that Hill was having a heart attack. She had to undergo open-heart surgery by Graham that night.

Hill made a full recovery. She credits Graham and the other hospital staff with saving her life.

She was lucky. Women benefit from prompt, evidence-based heart-disease therapies as much as men do, but studies show that they are less likely to receive such care. Research has also demonstrated that Black patients, especially Black women, also get less care for their heart attacks.

Though Hill’s story has a happy ending, it could have gone differently. Not only did she delay getting care, but she also had risk factors that should have been on her radar.

Heart attack risk factors
People who have a family history of cardiovascular disease are at an increased risk for a heart attack. That’s the case with Hill, whose mother passed away from heart failure and whose father died from a heart attack.

She also has a stressful job and works six days a week. Although researchers are still investigating the stress-heart health link, they do know that stress causes people to pick up unhealthy habits like excessive drinking, smoking, and poor eating and sleeping habits that negatively affect overall heart health.

“Stress will bring out your heart disease,” says Graham.

In addition to family history and life stress, other heart-attack risk factors include:

  • Sex: Though women commonly experience heart attacks, men are even more likely to have one.
  • Age: Risk increases for women after age 55 and for men after age 45.
  • Health conditions: Obesity, high blood pressure, high cholesterol, diabetes, and autoimmune diseases like lupus and rheumatoid arthritis can all raise heart attack risk.

You can’t change many of the major heart attack risk factors. But the good news is that lifestyle changes can lower your risk.

How you can prevent heart attacks
Exercises like walking, tai chi, yoga, biking, swimming, and water aerobics have been proven to boost heart health. The Centers for Disease Control and Prevention (CDC) recommends doing some form of moderate-intensity physical activity that keeps your heart rate up for at least 30 minutes, five days a week.

Here are four more ways to prevent heart attacks:

Talk to your HCP about your cardiovascular risk. They will determine if you need to be tested for heart disease.

You can’t always predict a heart attack. But you can be prepared by knowing your risk factors, nurturing your health, understanding that heart attack symptoms aren’t always obvious, and being attentive to how you feel. And be prepared to advocate for yourself if you do not think your HCP is taking your symptoms seriously.

“You have to listen to your body and take care of yourself,” says Hill. “If you feel like something is wrong, don’t wait—go to the doctor right away.”

Article sources open article sources

Centers for Disease Control and Prevention. How much physical activity do adults need? Last reviewed October 7, 2020.
Centers for Disease Control and Prevention. Heart Attack Symptoms, Risk, and Recovery. Last reviewed January 11, 2021.
American Heart Association. Aspirin and Heart Disease. Accessed January 26, 2022.
American Heart Association. Heart Attack Symptoms in Women. Last reviewed July 31, 2015.
American Heart Association policy fact sheet. Cardiovascular Disease: Women’s No. 1 Health Threat. Accessed January 26, 2022.
American Heart Association. Differences remain in heart attack treatments for black patients. September 20, 2018.
Cedars Sinai. Time: Women Die From Heart Attacks More Often Than Men. Here’s Why — and What Doctors Are Doing About It. Accessed January 26, 2022.
Mayo Clinic. Stress test. Accessed January 26, 2022.
Arora S, Stouffer GA, Kucharska-Newton A, et al. Fifteen-Year Trends in Management and Outcomes of Non-ST-Segment-Elevation Myocardial Infarction Among Black and White Patients: The ARIC Community Surveillance Study, 2000-2014. J Am Heart Assoc. 2018;7(19):e010203.
Emily Paulsen. Duke Health. Recognizing, Addressing Unintended Gender Bias in Patient Care. January 14, 2020.
US Preventive Services Task Force. Cardiovascular Disease Risk: Screening With Electrocardiography. June 12, 2018.

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