Heart Attack Symptoms Look Different In Women. Doctors Explain Why.

The public image of a heart attack was built from a male presentation: sudden, central, crushing chest pain radiating down the left arm. Plenty of women experience exactly that.

A significant proportion do not — and the resulting delay, on both sides of the consultation, is one of the better-documented inequities in acute medicine.

What the presentation can look like

Chest discomfort is still the most common symptom in women — but it is more often described as pressure, tightness or a squeezing ache than as pain, and it is more often accompanied by other symptoms.

Those include shortness of breath, nausea or vomiting, pain in the jaw, neck, back or either arm, light-headedness, cold sweats, and unusual fatigue that may have been building for days or weeks.

Why the difference exists

Part of it is anatomical. Women more frequently have disease in the smaller coronary vessels rather than a single large obstruction, a pattern that produces a more diffuse symptom picture and can look unremarkable on a standard angiogram.

“We spent decades calling that a normal result,” says Dr Mensah. “We now have a name for it — coronary microvascular dysfunction — and it is not benign.”

“A pregnancy history is a cardiovascular history. It belongs in the notes at every stage of life.”Aisha Mensah, MD

The risk factors specific to women

Pre-eclampsia, gestational diabetes and pre-term delivery all raise lifetime cardiovascular risk substantially. So do polycystic ovary syndrome, early menopause and autoimmune conditions such as lupus and rheumatoid arthritis.

“A pregnancy history is a cardiovascular history,” says Dr Mensah. “It belongs in the notes at every stage of life, and it is very often absent.”

What to do

Call emergency services rather than arranging your own transport. Chew aspirin only if instructed to. Say the words “I think I may be having a heart attack” — explicit language measurably changes triage.

If you are sent home and symptoms persist or recur, return. Asking for a high-sensitivity troponin and an ECG by name is entirely reasonable.

Prevention is the whole game

Blood pressure, lipids, HbA1c, smoking status and weekly activity remain the levers with the most evidence behind them. Blood pressure in particular is under-treated in women and is the single most modifiable risk factor.

Know your numbers by the age of forty. Know your mother's and sister's too.