Why Heart Attack Signs Differ in Men and Women

Women may have subtler symptoms.

couple facing each other laughing

Medically reviewed in February 2022

Updated on February 17, 2022

When you think of a heart attack, symptoms like chest pain and shortness of breath probably come to mind. But that’s not always the case for women. In fact, many women don’t even realize they’re having a heart attack.

“People are expecting the classical chest pain,” says Atiq Rehman, MD, chief of cardiovascular surgery at Genesis Health System in Columbus, Ohio. They may believe that if that doesn’t happen, then it’s not a heart attack, he adds: “But in real life, that’s not so.”

If the symptoms are atypical, or unusual, women may not seek medical care as fast as they should and the implications can be more severe, Dr. Rehman says.

Heart attack symptoms in women have been misunderstood
A heart attack happens when blood flow to the heart gets blocked, most often as the result of either undiagnosed or untreated heart disease. The sooner you seek treatment, the better your chance of surviving.

Healthcare providers and laypeople alike often consider heart attack symptoms that men normally experience as “typical” or “classic,” while symptoms that are more common in women are considered “atypical.” But that’s largely a function of how medical science was done in the past.

Because researchers for a long time assumed incorrectly that heart disease was a “man’s disease,” most initial studies of heart disease focused on men. In addition, in 1977, the U.S. Food and Drug Administration put out a guideline that banned women of childbearing age from participating in clinical trials. The intention was to protect them and unborn children from potential risks, but that protection came at the cost of neglecting comprehensive research. The FDA canceled the ban in 1993. It’s therefore only relatively recently that heart disease in women has received more scientific attention.

Heart attack symptoms to spot
No matter their sex, when people have a heart attack, they tend to experience:

  • Chest pain and pressure
  • Shortness of breath
  • Discomfort in the arms, shoulders, or neck

When women have a heart attack, they are most likely to have chest pain and discomfort. But they don’t always. They are also more likely than men to report other symptoms, including:

  • Shortness of breath
  • Nausea and vomiting
  • Back or jaw pain
  • Breaking out in a cold sweat
  • Pressure or pain in the lower chest or upper abdomen
  • Dizziness, lightheadedness, or fainting
  • Extreme fatigue
  • Heartburn or indigestion

Why women experience different symptoms

Experts don’t know definitively why women have different heart attack symptoms, but studies have turned up some important differences in the way men and women develop heart disease that may provide some explanation.

Women are more likely than men to have a heart attack that doesn’t involve a severe obstruction in a single artery. Menopause, in which female hormones decline, can raise the risk of heart disease in smaller blood vessels.

Women who have diabetes are more likely than men with diabetes to have heart disease—which may change their experience of a heart attack, since diabetes can change pain perception. Similarly, smoking seems to put women at higher risk of heart disease than men. Family history of heart disease at a young age also heavily affects women compared to men.

Psychosocial factors may also play a role.

In general, women tend to have more distractions in their lives, says Rehman. “If you have multiple distractions like work, family, and kids, all that creates undue anxiety, stress, or depression, which may mask classical symptoms of a heart attack.”

Women may assume their symptoms are caused by stress, or something else, and delay getting help. They may also expect not to be taken seriously in medical environments, or they may ignore their symptoms entirely. And women’s hearts are more heavily affected by emotional stress and depression than men’s are.

Again, the history of research on this topic means that what we know about heart disease derives mostly from studies of men. It could be that heart disease develops and shows up somewhat differently based on sex-specific factors. Even culture and gender expectations could play important roles. But the science is in progress, and federally funded researchers are now required to include women in studies of diseases that affect women.

Keys to prevention
Still, women don’t need to wait for the science to catch up before taking steps to protect themselves from heart disease. It starts with awareness.

“The first thing women need to understand is that heart disease is your number-one killer. It can happen to anyone,” says Rehman.

While there are certain risk factors for heart disease you can’t control, like genetics, there are plenty of things you can do to lower your chances.

“You need to maintain a healthy lifestyle,” says Rehman. “Avoid smoking, drink in moderation or avoid drinking. If you have high blood pressure or diabetes, make sure it’s controlled. And exercise.”

To protect your heart during a potential health crisis, listen to your body. If something feels off and you think you might possibly be having a heart attack, don’t delay. Call 911.

Article sources open article sources

Kreatsoulas C, Shannon HS, Giacomini M, Velianou JL, Anand SS. Reconstructing Angina: Cardiac Symptoms Are the Same in Women and Men. JAMA Intern Med. 2013;173(9):829–833.
DeVon HA, Rosenfeld A, Daya M. Cardiac Symptoms in Women and Men. JAMA Intern Med. 2013;173(20):1927–1928.
American Heart Association. Warning Signs of a Heart Attack. Accessed February 11, 2022.
American Heart Association. Heart Attack Symptoms in Women. July 31, 2015.
O'Neil A, Scovelle AJ, Milner AJ, Kavanagh A. Gender/Sex as a Social Determinant of Cardiovascular Risk. Circulation. 2018;137(8):854-864.
Hanna Gaggin and Andrew Oseran. Gender differences in cardiovascular disease: Women are less likely to be prescribed certain heart medications. October 15, 2020.
Mirin AA. Gender Disparity in the Funding of Diseases by the U.S. National Institutes of Health. J Womens Health (Larchmt). 2021;30(7):956-963.
US Department of Health and Human Services. OASH, Office on Women’s Health. Policy of inclusion of women in clinical trials. Page last updated April 1, 2019.
NIH Grants and Funding. Inclusion of Women and Minorities as Participants in Research Involving Human Subjects. Updated February 9, 2022.
Mayo Clinic. Heart disease in women: Understand symptoms and risk factors. January 20, 2022.

 

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