When we hear the term “heart attack” most of us have a pretty specific mental image that comes to mind — and for the most part, that vision includes an older man collapsing while clutching his chest or left arm. While said scenario isn’t unheard of, it’s not exclusively what a heart attack looks like. In fact, the symptoms and signs of a life-threatening heart attack can take many forms, and the truth is that an attack can look very different for a woman.
Over the past 15 years or so, campaigns by organizations like the American Heart Association have worked to raise awareness that despite the fact that it’s typically considered a male condition, heart disease is actually the leading cause of death of women in the United States. The risk is highest among women over the age of 50.
Just as a quick refresher, even though people tend to use the terms “heart attack” and “cardiac arrest” interchangeably, they are not the same thing. According to the American Heart Association, a heart attack occurs when blood flow to the heart is blocked, while cardiac arrest happens when the heart malfunctions and stops beating unexpectedly. Symptoms of cardiac arrest are a sudden loss of responsiveness and not breathing normally (for instance, if the person isn’t breathing at all or gasping for air).
With so much conflicting information out there, we spoke with two renowned cardiologists to get to the bottom of what women should be on the lookout for in terms of heart health. Here are a few tips.
Know the classic heart attack symptoms
Yes, heart attacks in women can and frequently do look different than those in men — and we’ll get to that in a minute. But to start with, Dr. John N. Bahadorani, an interventional cardiologist at the Saddleback Memorial Medical Center in Laguna Hills, California, says that there are actually more similarities than differences in symptoms between men and women, so knowing generally what to keep an eye out for is necessary.
Another similarity, according to Dr. Gregory S. Thomas, the medical director of the MemorialCare Heart & Vascular Institute in Long Beach, California, is that heart attack symptoms for both men and women become subtler with age. In fact, some heart attacks are so subtle, they are “silent,” he says, meaning that there is no pain or other symptoms to alert a patient that there heart does not receive enough blood flow. In these cases, the heart attack is picked up by an ECG or imaging test of the heart, rather than because of pain.
Here are the classic symptoms of a heart attack for both women and men according to Bahadorani:
- Chest pain or pressure “elephant sitting on my chest”’
- Gradual onset with waxing and waning of the intensity
- Provoked by exercise and relieved with rest and/or nitroglycerin
- Radiation of the pain to the shoulder (left more so than right), lower jaw, neck, back upper abdomen
- Associated symptoms of shortness of breath, sweat beading on the forehead, feeling cold/clammy, nausea, fatigue, numbness/tingling in the fingers
- Angina (pain as result of mismatch between myocardial oxygen demand and supply) typically lasts two to five minutes, while pain as a result of a heart attack can last for more than 30 minutes.
What’s different in women?
For women, heart attack symptoms may be in between the classic symptoms of pain in the chest and no symptoms at all, Thomas says.
According to both Bahadorani and Thomas, symptoms women in particular need to be aware of include:
- Sudden onset of weakness or fatigue
- Shortness of breath, lightheadedness and/or a fainting episode
- Nausea/indigestion and/or upper abdominal pain
- Body aches, including back pain
- A “burning sensation” in the chest
- An overall feeling of illness (without chest pain)
Also, women have a greater likelihood of their symptoms being induced at rest, during sleep and/or by mental stress as opposed to the typical correlation with physical exertion, Bahadorani says. He adds that for women, the most prominent symptoms in the chest region are discomfort, crushing, pressing or bad aches.
Why do women’s heart attacks sometimes go unnoticed?
Given the symptoms described above, it is often more difficult for a woman to tell that she is having a heart attack or a warning of a heart attack than a man. Along the same lines, it makes the diagnosis more difficult for physicians, Bahadorani says — particularly among younger women. As of yet, research has not shown us why there is a difference between women and men in this regard, according to Thomas.
So here’s the tricky part: Because women don’t typically get chest-clutching TV heart attacks and the symptoms tend to be ones they may encounter on a daily basis from menopause or aging in general, how do you know when to be concerned about your heart?
“This can be a challenge,” Thomas notes. “If pain is part of the constellation of symptoms, the closer the pain is to the chest, the more likely a heart attack or a warning of a heart attack has occurred.”
Another key, he says, is that the symptoms — including severe fatigue, fainting, severe sweating — come on fairly rapidly and are new, in which case they should be checked out by a physician.
What can you do about it?
It sounds cliché, but being aware of the symptoms is really important in order to be able to identify the early signs — especially if you’re already at risk.
“Woman who carry risk factors for heart disease such as high blood pressure, family history of premature coronary artery disease, elevated cholesterol, smokers or diabetes should be screened for symptoms of heart disease and should be considered for stress testing if there are any concerning findings upon clinical consultation,” Bahadorani says.
He also recommends making “aggressive risk factor and lifestyle modifications,” and if there are enough risk factors for coronary artery disease, physicians may recommend starting a baby aspirin.
There is good news: With better understanding that women and their symptoms are indeed different, the death rate from heart disease in women began decreasing in the year 2000 and has continued to do so, Thomas notes.
Originally published January 2010. Updated August 2017.