Heart Attacks and Women

We understand that gender is a spectrum. We may use gendered terms to talk about anatomy and health risk. Please use this information in a way that works best for you and your provider as you talk about your care.

Heart disease kills 1 out of 4 women in the U.S., according to the National Heart, Lung and Blood Institute.

Heart attacks and their aftermath tend to be more deadly in women. More women than men die within a year of having a heart attack. This may happen because women are generally older than men when they suffer heart attacks. Women also tend to think their symptoms are not those of a heart attack and don't seek immediate care. Further, women don't respond as well as men to the treatments usually prescribed during or after a heart attack. 

For many women, a heart attack may feel like a strange discomfort in the back or some other sign that is easy to ignore instead of crushing chest pain.

When women do go to the hospital, healthcare providers may miss the diagnosis of heart attack because the symptoms are not clear. Without a definite diagnosis, a woman may be sent home thinking that her symptoms don't mean anything serious. 

Studies confirm that heart disease may differ in women in ways that healthcare providers may not recognize. Heart disease in many women doesn't occur from obvious blockages in arteries as it does in men.

Instead, for women, plaque often spreads evenly along the artery wall or in the smaller arteries. This is called microvascular syndrome. Some experts suggest that changes in hormones connected to aging or inflammation may explain why women's smaller blood vessels are affected. These areas don't show up on an angiogram, the standard imaging test that measures blood flow in the big arteries.

Subtle signs

In women with microvascular syndrome, blood flow to the heart falls dangerously low. But women don't often feel the "elephant-on-the-chest" pain that takes place when large arteries shut down. Instead, they may have subtle symptoms. They may feel pressure or squeezing or shortness of breath. Symptoms may even pop up elsewhere in the body, such as the jaw. This symptom of jaw pain can also appear in men having a heart attack. Many women feel more tired than normal. Or they feel dizzy or lightheaded. Some may have pain in their stomach and think they have indigestion or heartburn.

Many women with this disease may continue to have symptoms and become sicker. They may be at an increased risk for heart attack within 5 years.

The stage for heart disease is set before menopause by factors such as high blood pressure, high cholesterol, extra weight (especially around the waist), high blood sugar, and smoking. All of these factors play a part in plaque buildup.

Warning signs

Women are more likely to have "nonclassic" heart attack symptoms than men. Still, healthcare providers note, unexplained jaw, shoulder, back, or arm pain can also signal a man's heart attack even when the classic crushing chest pain is absent.

These are the most common warning signals for heart attack:

• Pain or discomfort in the center of the chest that lasts more than a few minutes, or goes away and comes back

• Chest discomfort with sweating

• Pain that spreads from the chest to the arm, neck, or jaw

• Shortness of breath, tiredness, dizziness, or upset stomach. These are particularly common in women.

If you are at risk for heart disease and have any of these symptoms, call 911 right away. Time is a key factor in a heart attack because the longer the blockage remains untreated, the more heart muscle will die. Also, medicines that break down blockage in the arteries must be given within the first few hours. 

Check your blood pressure

Experts recommend that you have your blood pressure checked any time you see a healthcare provider, including visits to an OB/GYN provider.

High blood pressure is one of a group of symptoms called metabolic syndrome that also includes high cholesterol, high triglycerides (another type of blood fat), increased waist circumference, insulin resistance, and obesity.

Cholesterol levels in women

Before menopause, women tend to have high levels of HDL ("good") cholesterol. This gives some protection to their arteries. After menopause, HDL levels go down. Women have an increased risk for heart disease and heart attacks after menopause.

Any woman with microvascular disease, metabolic syndrome, or other heart disease risk factors needs treatment.

This often means taking medicine. But with mildly elevated numbers, lifestyle changes such as regular exercise and losing weight may help. Talk with your healthcare provider about your target LDL ("bad") cholesterol, HDL cholesterol, and triglycerides levels. 

For women with high cholesterol, high blood pressure, or diabetes, taking medicine is key to helping prevent heart disease. Exercise and diet are also important. Many women will need to make healthy lifestyle changes and take medicines to keep their risk factors under control.

Know your risk factors for heart disease

Preventing or controlling heart disease may mean making changes in the way you live. A healthy heart requires a personal action plan. But where do you start? A complete health checkup is a sensible first step, especially if you have many risk factors. Your healthcare provider can tell if you have cardiovascular disease or its risk factors. If so, they can help you with a practical treatment plan. Even if you don't have any risk factors now, you can discuss ways to lessen your chances of developing them.

Risk factors for cardiovascular disease that are specific to women include:

• Being postmenopausal

• Past hysterectomy

• Past or current use of birth control pills

• Pregnancy and the high-risk complications of pregnancy. These include diabetes, pre-eclampsia, and eclampsia.

Risk factors for developing cardiovascular disease that both men and women can have in common include:

• Personal history of atherosclerosis, including coronary artery disease, ischemic stroke, and peripheral arterial disease

• Age over 55

• Male relative (father or brother) under the age 55 or female relative (mother or sister) under the age of 65 with coronary heart disease

• High blood pressure

• High levels of LDL cholesterol or low levels of HDL cholesterol

• Type 1 or 2 diabetes

• Chronic kidney disease

• History of smoking or current smoker or tobacco user

• Not having an active lifestyle

• Having a larger body

• High-fat diet

• High-stress life