Heart Attack in Women: Why Symptoms Look Different
Cardiovascular disease kills more women than all cancers combined, according to the CDC — yet women are less likely to be screened, less likely to receive a timely diagnosis, and more likely to die from their first heart attack. A major reason: the symptoms are different, and they are routinely dismissed.
By Emanuel Papadakis, RDCS, RVT
Medically reviewed by Dr. Glenn Gandelman, MD, MPH, FACC, FASE — Board-Certified Cardiologist
2026-01-19
✓ARDMS Certified Sonographer
✓ASE Member — Echo Standards
✓IAC Accredited Cardiologist
✓Board-Certified Cardiologist Review
Heart attacks in women are frequently different from the textbook presentation of crushing chest pain radiating to the left arm. This difference has consequences: women wait longer to call for help, are more likely to be sent home from emergency departments without a cardiac diagnosis, and have higher in-hospital mortality from heart attack than men. The gap is not explained by biology alone. A significant part of it is awareness.
Why Heart Attacks Present Differently in Women
Heart attacks present differently in women largely because the underlying disease process differs from men's classic pattern. Women are significantly more likely to experience heart attacks from plaque erosion, spontaneous coronary artery dissection, or microvascular spasm rather than the single large artery blocked by ruptured plaque common in men, and these mechanisms don't always produce the dramatic ST-elevation pattern on EKG that triggers immediate catheterization.
The result is that women more frequently have heart attacks classified as NSTEMI, a non-ST-elevation myocardial infarction, which requires different diagnostic evaluation and is associated with delayed or less aggressive treatment in many hospital systems. Awareness of this pattern is essential both for patients and for the people around them.
Symptoms Women Report Before and During Heart Attack
Women having heart attacks often report symptoms far removed from classic chest pain, including unusual fatigue, sleep disturbance, shortness of breath, indigestion, and jaw or back pain. These symptoms can appear days or weeks before the event or during it, and any one of them warrants medical evaluation if it's new or unexplained.
›Unusual fatigue: Not ordinary tiredness but a profound exhaustion that comes on in the days or weeks before the event and is disproportionate to activity level
›Sleep disturbance: New inability to sleep or waking repeatedly, sometimes with mild chest discomfort
›Shortness of breath: Dyspnea occurring at rest or with minimal exertion, without accompanying chest pain
›Indigestion or nausea: Upper abdominal discomfort, nausea, or vomiting that is unexplained by diet or gastrointestinal history
›Jaw, neck, or upper back pain: Referred ischemic pain that does not involve the chest at all
›Chest pressure or discomfort: Present in many but not all female heart attacks, and often described as pressure rather than pain
›Lightheadedness or near-fainting: Dizziness without an obvious cause, particularly with exertion
Research published in Circulation found that 43 percent of women having heart attacks reported no chest pain at all, a pattern the American Heart Association highlights as a critical awareness gap. The presence or absence of chest pain is not a reliable indicator of whether a cardiac event is occurring.
The Diagnostic Gap and What to Do About It
The diagnostic gap is real: women with atypical symptoms are more often told their pain is anxiety, panic, or muscle strain before a cardiac workup happens. If you're experiencing the symptoms above and haven't had cardiac enzymes, an EKG, and imaging, ask your care team directly for that workup, and say clearly that you're concerned about your heart.
Bring a family member if possible, and name specifically that you are concerned about a cardiac cause.
For women who are not in an acute situation but have cardiac risk factors or have experienced any of the symptoms above intermittently, a preventive echocardiogram and carotid duplex provide objective structural information about the heart and arteries that cannot be minimized or attributed to non-cardiac causes.
After a Heart Attack: Cardiac Monitoring and Recovery
For women who have experienced a heart attack, serial echocardiography is used to monitor ejection fraction recovery, assess for mechanical complications, guide decisions about implantable devices, and evaluate the response to medical therapy. Women with preserved ejection fraction after MI require different management than those with reduced ejection fraction, and the echo is the tool that makes that distinction.
BlackPoint performs echocardiography and carotid duplex at your home throughout Southern Maine. $397 per scan. Results from Dr. Glenn Gandelman, MD, MPH, FACC, FASE within 24 to 48 hours. No referral required. For women with multiple risk factors, the Comprehensive Cardiac Package includes echocardiography plus carotid duplex in a single appointment.
