When we picture a heart attack, most of us imagine a specific scene: a middle-aged man clutches his chest, and collapses from sudden, intense chest pain. But this portrayal masks a critical and potentially life-threatening misconception – women’s heart attack symptoms often look and feel dramatically different, a reality that has been overlooked in medical research, public health messaging, and popular understanding for decades.
The consequences are stark and sobering. Heart disease remains the leading cause of death for women in the United States, claiming more lives each year than all forms of cancer combined. Yet awareness remains frustratingly low, and misconceptions persist. Tryon Medical Partners cardiology specialist Dr. Thompson shares the unique cardiovascular challenges women face, why heart attacks in women are so often misunderstood, and crucial information that could potentially save lives.
What is a heart attack or myocardial infarction (MI)?
A heart attack, also known as a myocardial infarction (MI), occurs when blood flow to the heart muscle is blocked, causing damage to the heart tissue. According to Dr. Thompson, without any intervention to unblock the blood flow, it takes three days for the muscle to actually “infarct” or die. The most common intervention is putting in a stent so that blood can flow freely again to the heart. Without a stent, decreased blood flow can cause the heart muscle to stop completely.
“If people can get to the hospital and into surgery within 90 minutes, the likelihood of significant myocardial damage is very low,” Dr. Thompson emphasizes. “If it takes longer than 90 minutes, it’s more likely there will be damage.”
Although heart attacks are often caused by underlying heart disease, heart disease is a broad term that encompasses many different conditions and symptoms. Heart disease in women (and men) includes:
- Blood vessel disease, such as coronary artery disease – this is the most common, and often causes heart attacks
- Irregular heartbeats, called arrhythmias
- Heart conditions that you’re born with, called congenital heart defects
- Disease of the heart muscle
- Heart valve disease
“Generally, the phrase ‘heart disease’ is used way too broadly,” Dr. Thompson explains. “It’s a very broad term that encompasses many processes in the heart. For each person, you have to work with your doctor to find out what kind of heart disease you might have.”
What are signs of a heart attack (MI) in women?
When people talk about classic heart attack symptoms, they typically describe:
- Chest pain that starts in the center of the chest, feels like pressure, and radiates down the left arm and up the neck
- Nausea
- Vomiting
- Paleness
- Lightheadedness
These symptoms typically progress rapidly over 5 to 30 minutes.
However, signs of a myocardial infarction, or heart attack, in women are often quite different. In fact, Dr. Thompson says, “It’s typical for symptoms to be atypical in female patients with myocardial infarction.”
For example, women often don’t have chest pain at all. Instead, they experience:
- Jaw pain
- Shortness of breath
- Profound fatigue (can’t get out of bed, hope it’s going to go away, and it doesn’t)
- Severe nausea
For women, they often only have one or two of these symptoms instead of all of them.
Why are men and women treated differently for heart attacks?
As Dr. Thompson explains, it’s been shown repeatedly that it takes longer for a heart attack diagnosis to be made in female patients. This is for several reasons:
- Female patients often don’t recognize their symptoms as a heart attack because they look different than people are expecting.
- Women are also more likely to write off their symptoms as nothing, which makes them less likely to call 911.
- Because they don’t present with chest pains, women’s heart attack symptoms are harder to identify, so healthcare clinicians often wait longer to give them an EKG and a stent.
“Because it takes longer to identify it as a heart attack, female patients often have delayed treatment and thus experience worse outcomes,” Dr. Thompson explains. “The longer you wait from 90 minutes after symptoms begin, the more heart muscle dies, which can ultimately lead to heart failure.”
How can women prevent heart disease and heart attacks?
In women, it can be more difficult to identify early symptoms of heart disease, such as high cholesterol and blood pressure. Often, the cholesterol and blood pressure numbers will look healthy for female patients until perimenopause, the transition period between a woman’s reproductive years and menopause, which typically begins in the late 30s or early 40s and lasts until 12 months after the final menstrual period.
Around perimenopause, their numbers start looking different – estrogen dips which causes blood pressure and bad cholesterol (LDL) levels to increase. Because they’ve never had problems before, women have a tendency to ignore those risk factors. Before they know it, they have untreated high blood pressure and cholesterol, putting them at higher risk for heart disease and heart attacks.
To prevent heart attacks and heart disease, Dr. Thompson recommends female patients:
- Make annual visits with their primary care clinician so blood pressure and cholesterol numbers are being checked and controlled.
- Exercise consistently to keep their heart healthy. This has the added benefit of making cardiac symptoms more noticeable: active patients often notice symptoms before their doctor because they notice a change in their body while they exercise.
- Avoid smoking. For a healthy heart, Dr. Thompson emphasizes how critical it is to avoid smoking – smoking is more impactful than having high blood pressure, high cholesterol, and diabetes.
“I’m optimistic that with more education, patients and clinicians will learn how women’s heart attack symptoms look different so they can identify them sooner,” Dr. Thompson notes. “Spreading the word is the key to saving lives.”
If you still have questions about heart disease or heart attacks in women, or need to schedule your annual appointment, use MedChat or call Tryon Medical Partners to meet with a clinician.