Heart Disease in Women: What You Need to Know

Several years ago, 2 people I knew had heart attacks. They each told me their story. The difference was striking. The first, a man, described the feeling of an elephant sitting on his chest. He quickly suspected he had a heart attack.

But the second, a woman, had trouble describing her vague symptoms. Suddenly, she "just felt terrible." She recalled walking around a farmer's market after her heart attack started. She felt lightheaded, broke out in a sweat, and felt nervous. She wondered if her blood sugar had dipped.

Hearing their stories drove home an important point: heart disease can be different for women. And it's important to know how and why.

How Heart Disease in Women Is Different

Heart disease in women is different in 2 ways. Sometimes we have different symptoms. And there are types of heart disease we're more likely to get.

Beyond Chest Pain: Different Heart Attack Symptoms

The most obvious sign of a heart attack is pain or tightness in the chest. But there are other, less obvious symptoms:

• Pressure, pain, or tightness in the arm, neck, shoulder, jaw, back, or abdomen
• Feeling of fullness
• Shortness of breath
• Fatigue or weakness
• Sleep problems
• Cold sweat
• Anxiety
• Indigestion
• Dizziness or lightheadedness
• Nausea or vomiting

It's important to know that women are more likely to have these less obvious symptoms. And like the woman who told me her story, we might not feel the big, obvious sign: chest pain. That makes it harder to spot a heart attack in women.

These more vague symptoms can come on days or weeks before, in addition to immediately before and during the heart attack.

Microvessel Problems & Artery Tears More Common in Women

“While women can certainly have blocked arteries, they have more problems than men with the very small vessels in the heart called microvessels,” says UVA Health cardiologist Angela Taylor, MD. 

You may notice chest pain and other symptoms if you have microvessel issues. But the most common heart tests won’t pick up on the problem. Providers can do special tests to catch it, Taylor says.

Another problem women are more likely to have? A dissection, or spontaneous tear, of the heart arteries. This also causes chest pain. It’s common after childbirth and from menopause-related hormonal changes, Taylor says. 

“While these problems are relatively rare, it’s important for women to be aware,” she says.

Heart Disease in Women: What the Differences Mean

These differences bring critical consequences for women.

We're more likely to face:

• Testing delays
• Treatment delays
• Misdiagnoses 

Know the Signs of Heart Attack in Women

We can combat this by knowing how heart disease in women is different. Knowing the different signs of heart attack is an important first step. That way, we're more likely to recognize a heart attack in ourselves or another woman, even when symptoms are vague.

When the above signs come on suddenly, get emergency care. If you suspect you or someone else is having a heart attack, dial 911 immediately.

If you have symptoms when you exert yourself, like during exercise, visit your primary care provider or a cardiologist, Taylor says. 

Make Time for Physicals

Annual exams and blood tests give your doctor important information about your heart and risk factors. They can help you with lifestyle changes or medications to reduce your risk of heart disease.

Advocate for Yourself

Your doctor may not bring up your heart health. Doctors are less likely to address heart health with women. Only 40% of women surveyed by the Women’s Heart Alliance had a heart health assessment during a routine physical. If your doctor doesn't mention it, make sure you do.