7 Overlooked Heart Attack Symptoms in Women

For decades, the image of a heart attack has been dominated by the portrayal of a man clutching his chest in sudden, crushing pain. While this “Hollywood heart attack” can occur, it is not the typical presentation for millions of women. Heart disease is the number one killer of women, surpassing all forms of cancer combined, yet the symptoms they experience are often subtle, vague, and easily mistaken for something less serious. This crucial difference in presentation is a primary reason why women are more likely to have a delayed diagnosis and worse outcomes after a heart attack. ^[1]

Understanding these “atypical” signs is a powerful tool in prevention and a critical step toward saving lives. This article will talk about 7 of the most common heart attack signs that women miss, explain the physiological reasons behind these differences, and provide a vital, step-by-step guide for what to do in those critical first moments.

The reason for the difference in heart attack symptoms between men and women is rooted in biology. While men are more likely to have blockages in the major coronary arteries (macrovascular disease), women more often experience blockages and damage in the smaller blood vessels that branch off from the main arteries (microvascular disease). ^[2] This condition is known as coronary microvascular disease (MVD). Furthermore, hormonal differences, particularly the role of estrogen, and how it impacts blood vessel health, contribute to the unique symptom profile. These subtle, diffuse blockages often lead to symptoms that are less about dramatic, localized chest pain and more about a general feeling of malaise, discomfort, and fatigue.

One of the most reported and overlooked symptoms in women is a sudden and overwhelming sense of fatigue. This is not the typical tiredness that comes from a long day; it is a profound exhaustion that can come on suddenly and is often described as feeling heavy, drained, or completely wiped out, even after a full night’s sleep. This symptom can occur in the days or even weeks leading up to a heart attack.

What to Do First: If you experience this extreme fatigue alongside other concerning symptoms, stop what you are doing immediately. Sit down, rest, and call 9-1-1. Do not try to “tough it out” or rationalize it as stress.

Instead of chest pain, many women feel a dull ache, pressure, or tightness in the upper body that can radiate to the jaw, neck, or throat. The discomfort may feel like a constant, uncomfortable pressure rather than a sharp pain and can be confused with muscle strain, stress, or even dental pain. ^[3] Some women report a choking sensation in the throat.

What to Do First: If you feel this type of pain, especially if it is accompanied by nausea or shortness of breath, do not assume it is a simple ache. Call emergency services immediately. Describe your symptoms clearly and state that you are concerned it could be a heart attack.

Difficulty breathing, often without any accompanying chest pain, is a hallmark symptom of a heart attack in women. This can feel like you’ve just run a marathon, even when you haven’t been active. It can be a sudden sensation of being unable to take a deep breath, and it may be accompanied by a feeling of heaviness in the chest.

What to Do First: If you suddenly feel short of breath and it doesn’t resolve with rest, it is a medical emergency. Call 9-1-1 and follow their instructions. The paramedics can provide oxygen and other life-saving care on the way to the hospital.

A heart attack can present as an upset stomach, a symptom that women often dismiss as the flu, food poisoning, or acid reflux. This discomfort can range from mild indigestion to severe, sharp stomach pain and is often accompanied by nausea and vomiting. ^[4] The vagus nerve, which runs from the heart to the brain, is a key player here, transmitting pain signals that can be misinterpreted as gastrointestinal distress.

What to Do First: If stomach discomfort is accompanied by any other red-flag symptoms, such as sweating or shortness of breath, do not take antacids. Call for emergency medical help immediately.

Feeling suddenly dizzy, lightheaded, or like you are about to faint can be a sign that your heart is not pumping enough blood to your brain. This symptom may come on suddenly and is particularly concerning if it is not due to a known cause like standing up too quickly.

What to Do First: Sit or lie down immediately to prevent falling and injury. Call 9-1-1. Let the dispatcher know you are feeling lightheaded and believe you may be having a heart attack.

While men typically feel pain radiating down their left arm, women may experience pain or discomfort in their upper back, shoulder blades, or either arm. The sensation can be a dull ache, a feeling of pressure, or a sudden, sharp pain that seems to have no logical cause, such as a muscle strain. ^[5]

What to Do First: If this pain is new, unexplained, and accompanied by other symptoms like shortness of breath or nausea, take it seriously. Call 9-1-1. Describe the pain’s location and intensity to the dispatcher.

While sleep issues are common, sudden changes in a woman’s sleep patterns can be a sign of an impending heart attack. This can include difficulty falling asleep, waking up frequently during the night, or waking up in a cold sweat. Research has shown that women who have had heart attacks often reported severe fatigue and unusual sleep disturbances in the month leading up to the event. ^[6]

What to Do First: If you suddenly develop severe sleep issues and are experiencing any other unusual symptoms, it is time to schedule a visit with your doctor. If the symptoms are acute, call emergency services.

In the face of a potential heart attack, every second counts. Knowing exactly what to do can be the difference between life and death.

1. Call 9-1-1 Immediately: This is the single most important step. Do not call a friend or family member for a ride, and do not drive yourself to the hospital. Emergency responders are equipped to provide life-saving care on the spot and can alert the hospital to your condition, ensuring that a cardiac team is ready for you the moment you arrive.
2. Rest and Sit Down: As soon as you suspect a heart attack, stop all activity and sit or lie down. This reduces the heart’s need for oxygen and can prevent further damage.
3. Take Aspirin (If Advised): If a medical professional or the 9-1-1 dispatcher advises it, chew a full-strength (325 mg) non-coated aspirin tablet. Chewing the aspirin helps it enter the bloodstream faster. Do not do this if you are allergic to aspirin or have been told by a doctor not to take it.
4. Stay Calm and Wait for Help: Panic and anxiety can increase your heart rate and put more stress on your heart. Try to take slow, deep breaths. Do not eat, drink, or take any other medications unless told to do so by a medical professional.

Heart disease in women is often silent, but it is not invisible. By understanding the risk factors and being vigilant about these less-obvious symptoms, women can become powerful advocates for their own health. The key is to trust your instincts and not dismiss unusual symptoms.

Risk factors for heart disease in women include family history, high blood pressure, high cholesterol, diabetes, and smoking. However, a woman’s risk also increases after menopause, as the protective effects of estrogen diminish. ^[8] Regular check-ups, a heart-healthy diet, and consistent physical activity are all critical components of prevention.

If you are a woman and you experience any of the symptoms discussed, you have a right to be taken seriously by a healthcare provider. Do not let your symptoms be dismissed as stress, anxiety, or something else. Be prepared to ask your doctor to test your heart health, and remember: early diagnosis and treatment are your best defense against heart disease.