Heart Attack Symptoms in Women and Why They Get Missed?

Heart problems are becoming more common in women. WHO data lists heart disease among the leading health concerns for women in India. Part of the reason it goes unnoticed is that we expect a heart attack to be sudden and severe with crushing chest pain. In women, the symptoms can be milder and more spread out. In this blog, we look at the heart attack symptoms in women that are worth a second look, why they get missed, and how to recognise them early.

Heart attack symptoms in women include chest pressure or tightness, pain spreading to the jaw, neck, back or arms, shortness of breath, nausea, cold sweat and unusual tiredness. Women are more likely than men to have these milder signs, sometimes without chest pain, so they are often missed.

What Do Heart Attack Symptoms in Women Look Like?

Common signs of a heart attack in women include:

• Chest discomfort that may feel like pressure, squeezing, fullness or tightness in the chest, often lasting more than a few minutes or coming and going
• Pain spreading to the jaw, neck, upper back, one or both arms, or upper abdomen
• Shortness of breath, with or without chest discomfort
• Nausea, vomiting or indigestion-like discomfort
• Cold sweat or light-headedness
• Unusual tiredness

Also Read: Early signs of heart blockage

Heart Attack in Women vs Men: Do Symptoms Feel Different?

Sometimes, yes. Chest pain or pressure is still the most common symptom in women, just like in men. But as mentioned above, women are more likely to also experience shortness of breath, nausea, jaw, neck or back pain, and unusual tiredness, and a few have a heart attack without chest pain at all.

Why Heart Attack Symptoms in Women Get Missed

There are a few layers to this.

• Symptoms can seem familiar Acid reflux, anxiety, muscle pain and menopause-related symptoms can feel similar, making it easy to mistake a heart problem for something else.
• Early tests may not catch every problem. An ECG can be normal in the early stages of a heart attack. Conditions affecting the heart’s small blood vessels may also go undetected on a standard angiogram. Repeat troponin blood tests and further investigations may be needed.
• Women may delay seeking help or experience delays in diagnosis. Recognising the symptoms early can help them get timely treatment and limit damage to the heart.

What Causes Heart Attacks in Women?

Most heart attacks in both men and women begin with a blockage from plaque in a coronary artery. Women can have this too, but they are more likely than men to have a heart attack with little or no major blockage on an angiogram. Some of the causes of heart attack in women are:

• Coronary microvascular disease: The heart’s smallest arteries don’t widen properly or go into spasm, so part of the heart muscle gets less blood than it needs, even when the large arteries look clear.
• Plaque erosion: The inner lining over a plaque is damaged, and a clot forms without the plaque rupturing. It is seen more often in women, particularly younger women.
• Spontaneous coronary artery dissection (SCAD): A tear forms in the artery wall, restricting blood flow. It is more common in younger women, and sometimes occurs during pregnancy or after delivery.

This is why a normal or near-normal angiogram does not always rule out a heart attack, and why further evaluation can be needed.

Heart Attack Risk Factors in Women

Many risk factors are the same in men and women. These include:

• High blood pressure
• Diabetes
• High cholesterol
• Smoking
• Excess weight
• Low physical activity
• Family history of early heart disease

Some factors are specific to women, or matter more in women:

• Menopause, especially early menopause
• Pregnancy complications such as preeclampsia, gestational diabetes or preterm delivery
• PCOS/PMOS
• Autoimmune conditions like lupus or rheumatoid arthritis
• Endometriosis and migraine with aura
• Chronic stress, depression and poor sleep

Having one of these risk factors does not mean you will have a heart problem. But it does mean regular checks of blood pressure, sugar and cholesterol are worth it. If you have had a complicated pregnancy or early menopause, mention it to your cardiologist, even if it was years ago.

Heart Attack Treatment: What It Involves

If you suspect a heart attack, don’t wait it out. Call an emergency service or have someone take you to the nearest hospital with cardiac care.

If a cardiologist has previously advised you on certain medication for emergencies, follow that advice. Otherwise, don’t self-medicate while waiting.

At the hospital, treatment usually starts with an ECG and blood tests. Depending on findings, it may include:

• Certain medicines or angioplasty with a stent to reopen a blocked artery
• Coronary artery bypass grafting (CABG), also called heart bypass surgery, in selected cases. It uses a healthy blood vessel, usually taken from the leg, chest or arm, to create a new route for blood around a blocked artery.
• Cardiac rehabilitation, which helps recovery and lowers the chance of another event
• Treatment for SCAD or microvascular disease can differ, which is why accurate diagnosis is important

Heart Attack Prevention and Screening for Women

A few simple habits can help protect your heart and prevent a heart attack.

• Get your blood pressure, blood sugar and cholesterol checked regularly
• Aim for about 30 to 40 minutes of physical activity every day
• Avoid tobacco and alcohol
• Eat more vegetables, pulses and whole grains, and less salt and fried food
• Talk to a cardiologist about heart screening around menopause

A healthy lifestyle lowers risk, but it doesn’t guarantee you will never have a heart problem. New symptoms are always worth getting checked.

Also Read: First aid for heart attack

Conclusion

Heart attack cases in women are increasing, and the signs can be easy to miss. Most of the time, there is nothing serious. But if a symptom is new, lasts longer than usual or comes with others like breathlessness, nausea or discomfort in the chest, jaw or back, it could be an early sign of a heart attack and is worth getting checked.

If your symptoms are sudden or severe, call an emergency service or go to the nearest hospital straight away. The CK Birla Hospital has emergency and trauma care to provide the immediate treatment you need. If you would like to talk about your heart health or heart attack treatment, you can book a consultation with our experienced cardiology team.