Is a Heart Attack in Women Different? Learn How to Recognize the Signs

A heart attack may be the first sign that you have heart disease, the leading cause of death in women. But for women, knowing when you’re having a heart attack may be more complex than you think. This is because women experience heart attacks differently than men. 

Women are less likely to have chest pain during a heart attack, but they’re more likely to have symptoms in other parts of their bodies. And many women also think about heart attacks as more of a “men’s health problem,” which means they may be less likely to get help when they need it.

We’ll explain how you can recognize the warning signs, when to get help, and ways to protect your heart.

Signs of a heart attack in women

Chest pain and chest pressure, especially with activity or stress, are the most common symptoms of a heart attack for everyone. But women are more likely to describe the pain as “tightness” or “discomfort” than men are. They are less likely to use the term “chest pain” when describing their symptoms.

But this is not the only major difference. Women are more likely than men to experience the following signs of a heart attack:

• Pain in the middle or upper back

• Jaw and throat discomfort 

• Nausea and/or vomiting

• Shortness of breath

• Waking up from sleep with shortness of breath

• Loss of appetite

• Generalized weakness and fatigue

• Cough

• Dizziness

• Palpitations

Causes and risk factors of heart attack in women

A heart attack happens when the heart muscle is deprived of blood flow and oxygen and the heart muscle begins to die. There are several different conditions that can cause this lack of  blood flow. Most of the time, it happens when someone has coronary artery disease. This is when there’s a buildup of plaque in the blood vessels, which can then lead to a blockage in the blood vessels that feed the heart muscle itself. 

There are many different risk factors for heart disease. Many of these risk factors you can’t control. These include your age, gender, and family history. But there are also risk factors you can have a little more control over, such as:

• High blood pressure

• High cholesterol

• High blood sugars

• Smoking

• Lack of physical movement and exercise

• Alcohol use

• Increased weight

EXPERT PICKS: WHAT TO READ NEXT

• Should you go to the ER for chest pain? Never delay care when you’re experiencing new chest pain. Especially if you have these symptoms. 

• Here’s what a heart attack feels like: Three women share their experience of a heart attack. And the warning signs they wish they had paid attention to beforehand. 

• Heart attacks in women under 50: Younger women are at risk for heart attacks caused by something called a coronary artery dissection.

There are also some risk factors for heart attacks that are unique to some women, such as:

• Birth control pills: The risk of heart attack or stroke is increased by 1.6 times in women taking certain birth control pills.

• Polycystic ovarian syndrome (PCOS): Women diagnosed with PCOS have a high number of other risk factors for heart disease.

• Pregnancy-related high blood pressure or diabetes: Developing gestational diabetes or pregnancy-induced hypertension increases the risk of heart disease in the future.

• Menopause: After menopause, women are at a greater risk of heart disease than premenopausal women.

How common are heart attacks in women?

Heart attacks and heart disease in women are more common than many think. Almost half of women in the U.S. (44%) have heart disease. It’s also the leading cause of death in women. About 1 in 5 women die from heart disease. 

Despite the fact that the same number of women and men die from heart disease each year, heart attacks and heart disease are still more likely to be associated with men. And surveys show that less than half of women know that heart disease is the leading cause of death.

What is the average age of heart attack in women?

Women tend to develop heart disease and heart attacks later in life than men do. The risk for a heart attack in women increases after age 55. The average age of a heart attack in women is 72 years old.

This is also important because research suggests that the older someone is, the less likely they are to experience chest pain from a heart attack.

Can a woman have a heart attack and not know it?

Yes, a woman can have a heart attack without knowing it. This is sometimes called a “silent heart attack” because it doesn’t produce any obvious chest pain symptoms.

This phenomenon has been studied more in men, but it certainly exists in women, too. Silent heart attacks may be more common than you think. The American Heart Association (AHA) estimates that as many as 1 in 5 heart attacks is “silent.”

A silent heart attack is usually diagnosed when an electrocardiogram (ECG) shows signs of prior heart damage. They are more common in:

• Men

• People over the age of 65

• Those with diabetes

Is the treatment for a heart attack different for women?

There are no differences in how heart attacks are treated in men and in women. But even though treatment is the same, there are some differences in practice. 

Women are less likely to: 

• Receive a stent to open a clogged heart artery than men are 

• Be prescribed medications that are proven to keep their hearts healthy 

• Have these medications dosed for the best chance of treatment success 

It’s unclear exactly why women are treated less aggressively. This may be due to differences in testing. For example, ECGs and cardiac catheterizations are often delayed for women compared with men. Women are also more likely than men to be treated by someone who’s not a cardiologist. 

Heart attack screening for women

Heart attack prevention — for both men and women — starts with screening for risk factors of heart disease. For all adults:

• Blood pressure should be checked at least once a year.

• Cholesterol should be checked at least once every 5 years.

• Blood sugar and diabetes screening should happen every 3 years.

It’s also important to discuss lifestyle modifications that can help with other risk factors, such as increased weight, smoking, and alcohol use.

It’s also good for women to know the circumstances and times when screenings should be prioritized.

Using oral contraceptive pills 

Many women use daily oral contraceptive pills (OCPs) for many different reasons — from pregnancy prevention to treatment for other medical conditions. OCPs can lead to an increase in blood pressure, so certain groups should avoid taking them. 

In women who take OCPs but have higher risk for heart disease — like those with a strong family history — regular home blood pressure monitoring is recommended. If you notice that your blood pressure is increasing while you’re taking OCPs, you should contact a healthcare professional. 

During pregnancy

All women should be screened for high blood pressure and high blood sugar during pregnancy:

• Blood pressure measurements should be taken throughout pregnancy at every prenatal appointment. 

• At 24 weeks of gestation, screening should be done to look for high blood sugar, which may be a sign of gestational diabetes. 

At the start of menopause

Women are protected against heart attack by high levels of estrogen when they are younger. But that protection disappears with menopause. 

Right now, it’s not recommended that women take hormones (called hormone replacement therapy or HRT) just to prevent heart disease. But research suggests that, in the first 10 years of menopause, taking HRT reduces your risk of heart disease. 

If you’re considering HRT for other reasons — like to help with symptoms of menopause — it’s important to discuss the pros and cons with a knowledgeable healthcare professional. Usually this is a primary care provider or gynecologist who knows your medical history well.

How to talk with a healthcare professional about heart attack symptoms

Research shows that healthcare professionals underdiagnose heart disease in women. While work is being done in the healthcare community to address this issue, women themselves should feel empowered to speak up about their symptoms. Especially if you’re concerned that your symptoms might indicate a heart attack. This can prevent medical bias from hurting you. 

Here are some actionable tips on how to talk with a healthcare professional about heart attack symptoms:

• If you are concerned about a heart attack, let everyone know what you are worried about. Freely use the words “chest pain” if that’s what you’re experiencing.

• Know your risk factors. Ask a healthcare professional: “What can I do to lower my risk of having a heart attack?” This can help to educate you more, and to let the healthcare professional know that this is something that you are concerned about.

• Not sure if your symptoms could be signs of heart disease? Let a healthcare professional know. Mild symptoms of a heart attack (like chest discomfort) that get worse with physical activity can be early warning signs that you are at high risk of having a heart attack. 

• If you have concerns or questions about your treatment for heart disease, this is the time to ask. You might ask, “Can you talk me through all of my options for treatment and what their potential risks and benefits are?” Another option: “Why did you choose this option for me instead of another option?” Or you could say, “Am I on the best doses of all of my medications to prevent having a heart attack in the future?”

It can be intimidating — especially when interacting with healthcare professionals you don’t know well — to speak up about your concerns. But this is the best way to make sure you’re getting your questions answered, and the treatment you deserve.

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Written by:

Meg Burke, MD

Meg Burke, MD, is a practicing primary care geriatrician in the Denver, Colorado area. She is board-certified in internal medicine and geriatric medicine, and received her undergraduate and medical degrees from Georgetown University in Washington, D.C. After graduating from medical school, Dr. Burke completed her internal medicine residency at Johns Hopkins Bayview Medical Center and her two years of subspecialty training in geriatric medicine at the Johns Hopkins Hospital in Baltimore, Maryland.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

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