Because these symptoms can be subtle, unexpected or different from the “classic” heart attack signs, they are often overlooked or misinterpreted. As a result, many women may not realize they need urgent care, which can delay care and be dangerous.

Heart disease is the leading cause of death for men and women in the United States, according to the American Heart Association. About 1 in 3 deaths each year among women* is related to cardiovascular disease.

“Time is muscle,” says Priya M. Freaney, MD, cardiologist and director of Women’s Heart Care at Northwestern Medicine. “The longer you let a heart attack brew, the more heart muscle you lose. That delay could cost you your life.”

Why Heart Attacks Can Look Different in Women

Dr. Freaney says these are some of the unique factors about heart disease in women:

• Heart attacks in women can sometimes develop from blockages in tiny blood vessels, spasms or tears in the arteries. These types of heart attacks can be harder to detect with standard cardiac tests.
• Pregnancy complications and the hormone changes of menopause can raise long-term heart risk.
• Some heart disease tests and treatments were designed mainly for men and may not always detect disease or work as well for women.
• Social factors like caregiving duties or less time for self-care can make managing heart health more challenging for women.

“Because heart disease doesn’t always look the same in women, recognizing these differences early can help prevent complications and save lives,” says Dr. Freaney.

She encourages women to trust their instincts.

“Women know their bodies,” she adds. “If you don’t feel right, especially if the feeling is new or different to you, get it checked out. It’s the only way to determine if you’re having a heart attack.”

What Is a Heart Attack?

A heart attack, also known as acute myocardial infarction, happens when your heart is lacking the necessary oxygen it needs to live and function properly.

Arteries deliver oxygen-rich blood to the heart. But fat, cholesterol and other substances can build up in the arteries, creating plaque along the arterial walls. This is called coronary artery disease. If the plaque breaks, a blood clot can form around the plaque and block blood flow to the heart.

When blood flow slows or stops, your body may send warning signs, such as chest pain or shortness of breath. Without fast treatment, the heart muscle can begin to die.

Heart attacks can also be caused by:

• A spasm in the coronary artery
• A tear in the coronary artery wall, known as spontaneous coronary artery dissection
• Poor blood flow in the heart’s smallest blood vessels

Why Blood Vessel Size Matters

Heart attacks in men often result from plaque buildup in the main coronary arteries. In women, in addition to buildup occurring in the main arteries, problems can occur in the tiny blood vessels, called the microvasculature.

“Think of your cardiovascular system as a tree. The tree trunk is the main coronary artery, and the root system underground are the microvascular blood vessels. These cannot be seen with the eye or fixed with a procedure.” says Dr. Freaney. “Men are more likely to have blockages in the large tree trunk. Women can get blockages in the tree trunk or in the root system underground.”

When you have a heart attack because of a major artery blockage, Dr. Freaney says the protocol is to open the blockage as soon as possible using a stent or bypass. But because warning signs in women are often less dramatic and standard testing can at times be inconclusive, women, on average, have delays in diagnosis and are less likely to have heart attacks treated in a timely manner.

Heart attacks can happen while you’re awake or asleep, too. They may come on when you’re physically active or when you’re experiencing physical or emotional stress.

Heart Attack Symptoms

Heart attack symptoms can be similar or different in women and men.

“For heart attacks, especially in women, we’re moving away from terms like ‘atypical symptoms.’ Instead, we say ‘less recognized’ or ‘underrecognized’ symptoms to describe what the patient is feeling,” says Dr. Freaney.

If you have any of these signs of a heart attack, call 911 and seek medical attention immediately.

Common symptoms in women

• Chest discomfort, pressure or a squeezing pain
• Shortness of breath
• Extreme fatigue or weakness
• Unexplained pain in your back, shoulder or jaw
• Dizziness
• Nausea
• Upper abdomen discomfort
• Indigestion
• Anxiety

Common symptoms in men

• Chest discomfort, pressure or a squeezing pain
• Shortness of breath
• Unexplained pain in your torso, neck, jaw, shoulders or arms
• Cold sweat
• Dizziness

Tell first responders and emergency department staff members about every symptom, even if it doesn’t seem heart-related.

“Make sure first responders hear that your symptoms don’t feel right to you,” says Dr. Freaney. “If you are able, you can tell them your risk factors, such as ‘I have high blood pressure,’ ‘I have very high cholesterol’ or ‘My father died early of a heart attack.’ This information will help focus their testing and treatment.”

Silent Heart Attacks

Sometimes, a person has mild or no symptoms at all. This is called a silent heart attack. 

“Silent heart attacks can occur in both women and men, and especially if a person has diabetes,” says Dr. Freaney.

Who Is at Risk for a Heart Attack?

Anyone can have a heart attack, but risk is higher with:

• High blood pressure
• High LDL (“bad”) cholesterol
• Family history of heart attack
• Diabetes
• Chronic stress
• Obesity
• Diet high in saturated fat

“Additionally, women may experience complications during pregnancy or hormonal changes during menopause, both of which can contribute to heart disease later in life,” says Dr. Freaney.

Risk factors that are unique to, or more common in, women:

• Preeclampsia or high blood pressure during pregnancy
• Gestational diabetes or high blood sugar during pregnancy
• Premature menopause (before age 40)
• Polycystic ovarian syndrome
• Autoimmune diseases, such as lupus

How Pregnancy Affects Heart Health

Women who have pregnancy complications, such as high blood pressure or high blood sugar, are at higher risk for developing heart disease later in life. These complications, known as adverse pregnancy outcomes, are closely linked to long-term cardiovascular health.

“Women with adverse pregnancy outcomes need to be especially vigilant about their cardiovascular care throughout their lives,” says Dr. Freaney.

Research shows that these women can remain at increased risk of dying from heart-related conditions for as long as 40 years after their pregnancy.

Soon after delivery, Dr. Freaney and her team educate patients at higher risk about the long-term cardiovascular effects of adverse pregnancy outcomes. They work together to create a personalized heart health plan that patients can follow for the rest of their lives.

How Menopause Affects Heart Health

As natural estrogen levels drop during menopause, the body changes.

• Cholesterol and blood pressure increases
• Belly fat increases
• Muscle mass decreases
• Arteries become more stiff
• Your energy level may drop, too

“All these changes taken together lead to an acceleration of heart disease risk in the years around menopause,” says Dr. Freaney. “The menopause transition is an important window to check in on heart health. Small heart-healthy habits before and during menopause can make a big difference long-term.”

Heart Attack Prevention Tips

Men and women can lower their risk by following these heart health tips:

• Know your numbers: blood pressure, cholesterol and blood sugar
• Eat heart-healthy foods: fruits, vegetables, whole grains and lean protein
• Stay active: at least 150 minutes of moderate intensity aerobic exercise weekly
• Achieve and maintain a healthy weight
• Do not smoke
• Manage stress

“Often, we hear women say they are so busy caring for other people that they don’t have time to care for themselves. But when you’re having a heart attack, a delay in going to the emergency room means a delay in diagnosis and a delay in getting the right treatment. Women must prioritize their own health,” says Dr. Freaney.

Talk to your doctor about your heart health and seek emergency assistance if you have any heart attack symptoms.

“There’s no reliable way to tell if you are having a heart attack without diagnostic testing,” explains Dr. Freaney. “Only a doctor can make that determination conclusively. That’s why it’s important you take your symptoms seriously and get checked out.”

*Scientists do not always collect information from participants about gender identity. To avoid misrepresenting the results of this research, we use the same terminology as the study authors.