Heart Attack Symptoms in Women: Why Are They Different From Men?

A distressing pattern we frequently encounter in our clinic is this: our female patients notice heart attack symptoms later than men and present later. The reason for this is not carelessness, but the fact that the symptoms genuinely look different. In this article I will explain why a heart attack follows a different course in women and what this difference leads to.

The Most Common Atypical Symptoms in Women

In female patients, instead of classical chest pain, more vague findings such as extreme fatigue, shortness of breath, a feeling of indigestion, back or jaw pain, nausea and sleeplessness often come to the fore. A large-scale registry study showed that about 42% of women having a heart attack described no chest pain at all; this can lead to a delay in diagnosis and to later arrival at hospital.

The Risk of Heart Disease After Menopause

Before menopause, the hormone oestrogen has a somewhat protective effect on women against cardiovascular disease; with menopause this protection decreases and the risk of cardiovascular disease in women rapidly approaches the level seen in men. For this reason we recommend keeping a closer watch on blood pressure, cholesterol and blood sugar in the post-menopausal period.

Why Women Notice a Heart Attack Late

Besides the symptoms being more vague, the social perception of a heart attack as a “man’s disease” can lead women to attribute their own complaints to stress or fatigue and postpone seeking help. As a result, our female patients often reach hospital later than men; yet the time it takes to open the blocked artery directly determines how much of the heart muscle will be permanently damaged.

Frequently Asked Questions

Can a heart attack occur without chest pain? Yes; especially in women, heart attacks that present without chest pain, with only fatigue or a feeling of indigestion, are common.

Which screenings should I have after menopause? We recommend having your blood pressure, cholesterol and blood sugar measured at regular intervals, together with a cardiology assessment if needed.

Is the treatment of a heart attack in women different from men? The principles of treatment are essentially the same; however, because the symptoms are different, a higher level of awareness is required so that diagnosis is not delayed.

Conclusion

The fact that a heart attack in women can follow a different and more insidious course than in men requires both patients and physicians to have this awareness. New, unexplained fatigue, shortness of breath or a feeling of indigestion must be taken seriously, especially in the post-menopausal period.

If you are in the post-menopausal period or have complaints such as unexplained fatigue or shortness of breath, you can book an appointment for a detailed cardiological assessment.

References

1. Mehta LS, Beckie TM, DeVon HA, et al. Acute Myocardial Infarction in Women: A Scientific Statement From the American Heart Association. Circulation. 2016;133(9):916-947.
2. Canto JG, Rogers WJ, Goldberg RJ, et al. Association of Age and Sex With Myocardial Infarction Symptom Presentation and In-Hospital Mortality. JAMA. 2012;307(8):813-822.