Women shouldn’t ignore or minimize chest pain – or other heart attack symptoms

February 1, 2023

Rina Mauricio, M.D. Internal Medicine - Cardiology

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Many women and some health care providers downplay the threat heart disease poses to women's health. If you experience chest pain or other symptoms of heart disease, even if you lead an active lifestyle, you should talk to a doctor and get checked.

“I have chest pain.” This statement should flag health care providers to evaluate a patient for a possible heart attack. And that typically happens when men say it.

But when women mention chest pain, two potential problems arise:

Women might group their chest pain with other symptoms, unintentionally de-emphasizing it: “My chest and jaw hurt, and I have been feeling tired and sweaty, with a bit of nausea.”
Providers may default to a dangerous stereotype that women don’t have heart attacks often and suggest another common cause for their symptoms, such as anxiety.

Both scenarios can lead to a delayed diagnosis, which is one reason why more women than men die from heart attacks every year. According to the American Heart Association (AHA), 26% of women will die within a year of having a heart attack, compared with 19% of men. The gap widens five years after a heart attack, with half of women dying compared with 36% of men.

We’ve made a lot of progress over the years in recognizing that heart attack symptoms can vary between women and men. Along with chest pain, women are more likely to experience accompanying symptoms such as shortness of breath, nausea, vomiting, and back or jaw pain. However, we still have a long way to go when it comes to educating patients and some providers about women’s heart attack symptoms – and treating women’s heart symptoms as quickly as we do men’s.

Heart disease is the leading cause of death for women in the U.S. Just recognizing this fact is an important first step, because about half of women are unaware how significant a threat heart disease poses to their health. Providers also must listen more closely for clues about heart attack symptoms.

As a society, we need to emphasize that heart disease doesn’t discriminate – women and men are at risk and should feel confident advocating for the best heart testing and care.

Experiencing chest pain? Say so. And keep saying it!

One of the top 10 take-home messages from the 2021 AHA guidelines for chest pain evaluation and diagnosis is that while chest pain is the most frequent heart attack symptom, women are more likely to present with accompanying symptoms such as nausea and shortness of breath.

Medical providers are trained to hear cues like “chest pain” or “squeezing in my chest.” Unfortunately, they may miss phrases like “chest discomfort” or “tightness” if you’re describing a long list of symptoms. While you should mention other symptoms, be sure the health care professional knows specifically that you are having chest pain.

Say it up front. Say it multiple times. Ask if they heard you.

Chest pain doesn’t always mean you’re having a heart attack. But it does mean something is wrong. Don’t ignore or downplay it, and make sure your health care provider has heard you.

Chest pain doesn’t have to be severe to get help

Women who’ve had heart attacks often tell me, “The pain wasn’t that bad, so I just ignored it.” Don’t wait to see a doctor until it’s the worst pain imaginable. Trust your gut, and if something feels like it’s not right, get your symptoms checked. If you have chest pain that keeps occurring, tell your doctor. Angina, or recurring chest pain, can be a sign of coronary artery disease (blocked or narrow blood vessels) or an imminent heart attack.

Be aware of gender disparities in heart care

At UT Southwestern, cardiac rehabilitation plays an essential role for patients who are recovering after a major cardiovascular event.

A study published in the Journal of the American Heart Association in 2022 revealed that women who present with chest pain are 4% less likely than men to be evaluated for emergency care or to have an electrocardiogram, which checks electrical activity in the heart and can indicate a heart attack. The study also found that women with chest pain are not seen by a doctor as quickly as men and are 5.5% less likely to be admitted to the hospital for observation.

Similarly, women are 12% less likely to be referred to cardiac rehabilitation, according to the AHA, even though it can substantially improve short and long-term quality of life after a heart attack. Patients who complete cardiac rehab typically have higher energy levels, better overall mood, and increased independence.

Providers should acknowledge these gender disparities and make a point to bring up – and emphasize the importance of – cardiac rehab to women and their family members. Educating patients and families is key in reducing long-term, preventable health problems.

Heart attack symptoms in women

Chest pain may be the most common and recognizable symptom of a heart attack. Women are also likely to experience associated symptoms, such as:

Cold sweat
Extreme fatigue
Indigestion or heartburn
Lightheadedness or feeling faint
Nausea or vomiting
Pain in one or both arms
Pain in the back, neck, jaw, or stomach
Shortness of breath

Often, these symptoms appear in clusters for women, but you should see a doctor if you have any of these symptoms.

If you have sudden heart attack symptoms, call 911 or seek emergency care immediately.

Women’s heart disease risk factors

There are steps you can take to decrease your risk of coronary artery disease, hypertension, and heart failure. Knowing common risk factors for women and men is the first step, including:

High blood pressure or high cholesterol
Diabetes
Obesity or overweight
Smoking and vaping
Physical inactivity
Family history of heart disease
Older age

Women face a few additional risk factors for developing heart disease. Research has shown that women with a history of early menopause are at increased risk for heart disease. Around the time of menopause, a woman’s risk of heart attack increases due to shifting hormone levels. If you go on hormone replacement therapy, it’s typically recommended you take it for the shortest duration of time needed to control symptoms, and at the lowest dose possible.

Having polycystic ovarian syndrome (PCOS) also can increase your risk of heart disease because it raises your chances of being overweight or obese, and having diabetes and high blood pressure – all of which are associated with heart disease.

Certain pregnancy complications also raise a woman’s risk of heart disease later in life. Preeclampsia and gestational diabetes double a woman’s risk of heart disease and stroke.

Heart care questions to ask your doctor

Your primary care provider should be monitoring and discussing heart health with you regularly. Together, you can reduce or manage risk factors through lifestyle changes, medication, or both.

If they don’t regularly bring up heart health, don’t hesitate to ask questions, such as:

I haven’t had my cholesterol checked in years. Is that something I should consider?
Should I be checking my blood pressure regularly at home?
I had preeclampsia or gestational diabetes when I was pregnant. What does that mean for my heart health?
Are there any heart screening tests I should consider?

If you have more questions or would feel more comfortable, make an appointment with a cardiologist or ask to be referred to one.

Many women put caring for others ahead of caring for themselves. If you’re experiencing heart attack symptoms, don’t ignore them or worry you’re overreacting. Prioritizing your heart health makes sense for you and your loved ones.

To discuss your heart health or concerning symptoms, call 214-645-8300 or request an appointment online.