Warning Signs of Heart Attack in Women
Women experiencing heart attack symptoms should be aware that they may present with both typical chest pain AND additional symptoms that differ from men, including nausea, back pain, dizziness, and palpitations. 1
Common Heart Attack Symptoms in Women
Primary Symptoms
- Chest pain, pressure, tightness, or heaviness remains the most common symptom in women with heart attack, occurring at similar rates as in men (88.5% of women vs. 94.8% of men) 2
- Central/substernal compression or crushing chest pain 1
- Pressure, tightness, heaviness, cramping, burning, or aching sensation in the chest 1
- Pain that radiates to neck, jaw, shoulders, back, or one or both arms 1
Associated Symptoms More Common in Women
- Nausea and vomiting (53.8% of women vs. 29.5% of men) 2
- Back pain (42.3% of women vs. 14.5% of men) 2
- Dizziness or lightheadedness (17.3% of women vs. 7.5% of men) 2
- Palpitations (11.5% of women vs. 2.9% of men) 2
- Unexplained indigestion, belching, or epigastric pain 1
- Persistent shortness of breath 1
- Diaphoresis (sweating) 1
Important Considerations for Women
Symptom Presentation Differences
- Women typically report more symptoms overall than men (73.1% of women vs. 48.0% of men report more than 3 symptoms) 2
- Women may present with atypical symptoms more frequently than men 1
- Symptoms may include fatigue or weakness that might be dismissed as less serious 1
- Women are at risk for underdiagnosis, so potential cardiac causes should always be considered 1
Risk Factors and Underlying Mechanisms
- Women with heart attacks are often 8-10 years older than their male counterparts 1
- Women have higher rates of traditional cardiovascular risk factors including hypertension (66.6% vs. 63.2%), hyperlipidemia (68.9% vs. 66.3%), and family history of premature coronary artery disease (34.6% vs. 29.3%) 1
- Diabetes is a stronger risk factor for heart attack in women than in men 1
- Women have a higher proportion of heart attacks caused by mechanisms other than classical plaque rupture, including:
- Plaque erosion
- Coronary microvascular dysfunction
- Coronary vasospasm
- Spontaneous coronary artery dissection
- Stress-related (Takotsubo) cardiomyopathy 1
When to Seek Emergency Care
- Call 9-1-1 immediately if experiencing chest discomfort/pain that is unimproved or worsening after 5 minutes 1
- Do not delay seeking care to self-medicate 1
- Women tend to present to hospitals later after symptom onset (median symptoms-to-door time 300 vs. 238 minutes for men), which may contribute to worse outcomes 1
Special Considerations
- Women with diabetes may have atypical presentations due to autonomic dysfunction 1
- Elderly women may present with generalized weakness, stroke, syncope, or changes in mental status rather than classic symptoms 1
- Relief with nitroglycerin is not necessarily diagnostic of myocardial ischemia and should not be used as a diagnostic criterion 1
- Women are less likely to receive timely and appropriate care for heart attacks 1