By Avni Dalal, ND
Heart disease remains the leading cause of death among women worldwide, but it often goes unrecognized until it’s too late. The risk of cardiovascular diseases (CVD) in women changes significantly with age, particularly when menopause occurs. Before the age of 55, women generally have a lower risk of CVD compared to men, thanks to the protective effects of estrogen. However, after menopause, women’s risk of heart disease increases dramatically and aligns with that of men, largely due to the decline in estrogen levels. This shift highlights the crucial role hormones play in heart health, making it essential for women, especially postmenopausal women, to be aware of the symptoms and risks associated with heart disease.
Heart attack symptoms in women can differ from the "classic" signs typically associated with men, which is why recognizing these subtle differences is critical for timely medical intervention. With that in mind, this blog will cover the symptoms of heart attacks in women, risk factors, when to seek medical intervention, and helpful tips for prevention.
What Is a Heart Attack?
A heart attack, or in medical terms called a myocardial infarction (MI), occurs when blood flow to a part of the heart is blocked–depriving the heart muscle of oxygen. Without prompt intervention, this damage can become irreversible. The most common cause of the blood flow obstruction is a blockage in one or more coronary arteries due to plaque buildup or a blood clot.
Symptoms of a Heart Attack in Women
Women often experience heart attack symptoms that are broader in range or may present differently from those in men. While chest pain or chest discomfort is considered the hallmark symptoms, it may not always present in the expected manner. Here are some other and less typical symptoms:
- Pain or discomfort in other parts of the body: Women frequently report pain in the left shoulder, arm, or hand; pain in the throat or jaw; pain in the upper abdomen; or pain between the shoulder blades. This pain is often described as pressure, tightness, or a squeezing sensation that may not be severe.1-4
- Shortness of breath (SOB): This typically feels like an inability to take a full breath, especially with even mild exertion like going up a flight of stairs or getting up from a seated position. SOB can occur with or without chest pain.1-4
- Fatigue: Unexplained or extreme fatigue is a common warning sign in women, even days or weeks before a heart attack. This may include feeling exhausted after minimal physical activity.1-4
- Nausea or vomiting: Some women experience indigestion-like symptoms, discomfort in the epigastric (upper central region of the abdomen), or even vomiting.1-4
- Dizziness or lightheadedness: This may feel like the room is spinning or as though you’re about to faint.1-4
- Cold sweats or sense of dread/fear of death: Many women may experience a sudden, clammy sweating or sense of dread without an obvious cause.1-4
While reading the list above, you may be thinking to yourself, “Oh gosh, I’ve definitely experienced one or more of these.” Not to fret; we will next cover why symptoms are different in women and delve into some of the risk factors so you have a deeper understanding.
Why Are Symptoms of Heart Attack Different in Women?
Hormonal differences, body size, and the prevalence of microvascular disease (damage to smaller coronary arteries) in women are thought to contribute to these differing symptoms. Additionally, societal misconceptions about what a heart attack “looks like” may delay women from seeking help, as many women may experience symptoms precipitated by mental or emotional stress rather than physical exertion.5
Understanding the Common Risk Factors of Heart Attack in Women
The common risk factors for heart attacks in women include both traditional and unique factors. Traditional risk factors that are particularly significant in women and that have a more pronounced impact on women compared to men include high blood pressure (hypertension), diabetes (type 2 diabetes mellitus), elevated lipids (hyperlipidemia), smoking, obesity, and a sedentary lifestyle.6,7 Diabetes and hypertension specifically confer a higher relative risk of MI in women.6,8
Additionally, women are affected by unique risk factors related to reproductive health and hormonal influences. These include adverse pregnancy outcomes such as preeclampsia, gestational diabetes, and gestational hypertension, which are all associated with an increased risk of future cardiovascular disease.9 Early menopause and polycystic ovary syndrome (PCOS) are also significant risk factors.9
A key factor in the increased postmenopausal risk is the decline in estrogen levels. Estrogen plays a protective role by helping maintain healthy blood vessels, regulate cholesterol levels, and promote circulation. As estrogen levels drop after menopause, women may become more prone to the development of plaque in their arteries, therefore leading to increased risk of heart attacks.
We also cannot negate the effect of psychosocial factors such as depression, anxiety, and low socioeconomic status and its crucial role in increasing the risk of MI in women.9 Lastly, autoimmune conditions, such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA), are more prevalent in women and contribute to higher cardiovascular risk.6,9
Knowing your numbers (e.g., blood pressure, cholesterol levels, and glucose levels) and being proactive about maintaining a healthy lifestyle are critical to minimizing your risk.
When to See a Doctor
If you experience any of the symptoms listed above, particularly if they are sudden or unexplained, you should:
- Call 911 immediately: Don’t wait to see if symptoms go away. Taking quick action can save your life.
- Speak up clearly: When paramedics or healthcare providers arrive, describe your symptoms in as much detail as possible. It’s important to mention any history of heart problems or risk factors.
- Don’t self-diagnose: It’s easy to attribute or minimize symptoms like fatigue or indigestion to stress or other conditions, but it is always better to be safe than sorry.
When you arrive at the hospital, doctors will likely perform several tests for women suspected of having an MI, including an electrocardiogram (ECG) to measure the heart’s electrical activity to detect damage, various blood tests to look for markers of heart damage such as troponin, and noninvasive imaging tests like stress echocardiography or coronary computed tomography angiography (CCTA) to assess blockages.10-13 Having an early diagnosis improves survival rates and reduces risk of long-term complications.
Heart Attack Prevention Tips for Women
To reduce the risk of MI in women, especially considering their unique risk factors, the following lifestyle modifications are supported by the American Heart Association and the American College of Cardiology:
- Smoking cessation: Women should be advised to stop smoking and avoid exposure to secondhand smoke.14,15
- Physical activity: Women should engage in at least 150 minutes of moderate-intensity exercise or 75 minutes of vigorous-intensity exercise per week with muscle-strengthening activities being performed on two or more days per week.14,15
- Dietary modifications: A heart-healthy diet rich in fruits, vegetables, whole grains, high-fiber foods, and fish (especially omega-3 rich fish) should be encouraged.14,15 Conversely, intake of saturated fats, cholesterol, sodium, and trans fat should be limited.14,15
- Stress management: Consider mindfulness practices like yoga or meditation and seek mental health support to help address depression, anxiety, and other psychosocial stressors.16
- Regular monitoring and risk factor management: Regular health check-ups can help detect issues early. Women with a history of adverse pregnancy outcomes, early menopause, or PCOS should have regular cardiovascular assessments.16,17
References:
1. Kirchberger I et al. The American Journal of Cardiology. 2011;107(11):1585-1589.
2. van Oosterhout REM et al. Journal of the American Heart Association. 2020;9(9):e014733.
3. Lichtman JH et al. Circulation. 2018;137(8):781-790.
4. Cardeillac M et al. Journal of Clinical Medicine. 2022;11(5):1319.
5. Mieres JH et al. Circulation. 2014;130(4):350-379.
6. Lu Y et al. JAMA Network Open. 2022;5(5):e229953.
7. Mehta PK et al. Trends in Cardiovascular Medicine. 2015;25(2):140-151.
8. Millett ERC et al. BMJ (Clinical Research Ed.). 2018;363:k4247.
9. Brown HL et al. Circulation. 2018;137(24):e843-e852.
10. Anderson JL et al. The New England Journal of Medicine. 2017;376(21):2053-2064.
11. Gulati M et al. Circulation. 2021;144(22):e368-e454.
12. Neumann JT et al. The New England Journal of Medicine. 2019;380(26):2529-2540.
13. Mieres JH et al. Circulation. 2014;130(4):350-379.
14. Mosca L et al. Journal of the American College of Cardiology. 2011;57(12):1404-1423.
15. Mosca L et al. Circulation. 2011;123(11):1243-1262.
16. Westfall E et al. American Family Physician. 2023;108(6):595-604.
17. Parikh NI et al. Circulation. 2021;143(18):e902-e916.
