When you think of a heart attack, the image that likely comes to mind is a person clutching at their chest or feeling numbness in their left arm. Whether you intended to or not, this conjured image was probably a guy.
For a while, heart problems were thought of as a man’s disease. And for good reason — heart disease is the leading cause of death in American men. But that doesn’t mean women are immune to problems of the heart.
We now know that heart attacks are a danger to both men and women. In fact, one in five women die from heart disease. Older women are especially vulnerable. The National Institute of Health (NIH) reports women getting more heart attacks at older ages than men. Menopause is likely the culprit as the drop in estrogen increases belly fat, high blood pressure, and other factors that increase a person’s risk of clogged arteries.
“Misdiagnosis and under-treatment are critical pieces to the reason that women die of heart disease more than all cancers combined,” says Suzanne Steinbaum, MD, a cardiologist who specializes in menopausal women’s health. “If there are risk factors and a woman is postmenopausal, she should be assessed for evidence of plaque in the arteries.”
The issue is that the hallmark symptoms we associate with heart attacks like chest pain happen more in men than women. A now well-cited 2003 NIH study found that just 30 percent of the 515 women surveyed had any kind of chest discomfort while they experienced a heart attack.
Related story
We Need to Talk About Mental Health Services for People of Color
Heart attack symptoms for women can be distressingly more vague and subtle. But as problematic as heart attacks are for women, they are also one of the most preventable. Recognizing early warning signs can help you put the brakes on an impending heart attack.
Extreme fatigue
Extreme and unexplained tiredness is one of the most reported heart attack symptoms among women. That’s because your heart is under massive stress as it tries to pump blood to a blocked area.
In the NIH study, 70 percent of women reported a wave of fatigue that creeps up a month or two before the actual attack. The fatigue should be so detrimental that it affects your day-to-day activities.
“For some, it’s so severe that they can’t make a bed without resting as they tuck the sheets. It interferes with their normal activities,” Jean C. McSweeney, PhD, a professor at the University of Arkansas for Medical Sciences in Little Rock, told NBC News.
Sleep disturbance
If you’re suddenly having trouble sleeping at night, this could be your body warning you of high blood pressure. High blood pressure is one of the major risk factors for a heart attack. Blood pressure normally goes down during sleep but when you have trouble sleeping, it stays elevated. A 2023 study in Clinical Cardiology found that insomnia and getting less than 5 hours of sleep is both associated with an increased risk of heart attack years after.
As you wake up, your heart rate and blood pressure spikes causing cardiac stress as your heart works harder to get you up and moving.
Back, neck, or jaw pain
When an artery is clogged and blood flow is blocked, people can feel an immense pressure or squeezing in their chest. Women more than men are more likely to experience the painful pressure in other places such as the upper back, neck, and jaw, and shoulder blades. “If it happens during times of exertion, it should be taken seriously,” Radha Kachhy, MD, a cardiologist told DukeHealth. “One of my patients said her shoulder hurt every time she walked. She thought it was her purse, but her shoulder throbbed even when she wasn’t holding her purse.”
The discomforting pressure can start off gradual or intense and may even come and go before becoming impossible to ignore.
Indigestion
Heart failure can cause abdominal swelling, which can appear as indigestion. Nearly 40 percent of women report indigestion a month before the cardiac event.
Other tell-tale signs that are often overlooked are nausea, lack of appetite, and vomiting. Puking because of heart problems is called cardiogenic vomiting. When the heart is too injured or is unable to receive oxygen-rich blood, heart tissue starts to die. The dying heart cells releases toxins that stimulate the nerves in charge of vomiting, giving you that sick to your stomach feeling.
“Heart attacks are more commonly missed in women and usually manifest as nausea and vomiting in women, more so than men,” Jeffrey Ko, MD, an assistant clinical professor of health sciences told UC Davis Health. “If you’re a woman over the age of 50, with other contributing factors such as diabetes or obesity and having these symptoms, it is advisable to go to the closest emergency room.”
Flu-like symptoms
Past experience tells you waking up with chills, sweating, and light-headedness means you’re coming down with the flu. However, for women, the flu-like symptoms could indicate an upcoming heart attack.
Julia Allen shared her story on a heart attack she experienced at 44 to Women’s Health. Initially, she mistook it for influenza. “I felt an immediate and extreme — almost like someone shutting a door on you — sense of flu symptoms. Keep in mind, all of my flu symptoms were EXTREME. I felt tired, weak, dizzy, and nauseous.”
Liz Johnson—then 39—told the American Heart Association how her flu-like symptoms were interfering with her ability to teach. She later went to the ER where they discovered she was having a heart attack. The flu-like symptoms Johnson experienced are common for people with spontaneous coronary artery dissection (SCAD). This is when there is a tear in the artery wall, letting blood pool between the layers of the artery wall. The resulting bulge from the wall blocks blood flow and damages the heart muscle. SCAD can happen at any age but is most common among women between 30 and 50.
Anxiety
Anxiety is a way of life for most Americans in today’s society. More than 40 million adults have an anxiety disorder. But if you notice unusual bouts of stress or feelings of “impending doom,” take a minute to breathe. Your anxiety may be trying to tell you something.
Thirty-five percent of women in the NIH study reported feelings of anxiety during their heart attack. And unlike a panic attack, the anxiety-like feeling will not go away. It may even increase in intensity over time. The anxiety stemming from a coming heart attack will also be accompanied by other physical symptoms.
