Unusual Heart Attack Symptoms in Women—and 6 Risk Factors You Should Know.

In the U.S., heart disease is the leading cause of death among women, claiming more lives than all types of cancers combined. Cardiovascular disease is responsible for of one in three deaths among women each year.

Go Red for Women, the annual February campaign to raise awareness about women’s heart health, has been going strong since 2004. Still, the myth persists that heart attack and stroke are “men’s diseases”—a myth even health care providers once believed. 

Today we know that women should be just as aware as men about their heart health across their lifespan. Recent studies indicate that heart attack rates are rising among women ages 35-54, emphasizing the need for early intervention and education about the warning signs and symptoms of a heart attack. 

Women should know that they can have subtle symptoms, making diagnosis more challenging. In addition, women may have  unique risk factors across the full span of their life, ranging from getting your period at a young age, to having anxiety, or an autoimmune disorder.  Despite the fact that heart disease doesn't always leave the visible changes that strokes or breast cancer can, it’s impact can be no less devastating. Hiding or ignoring symptoms, no matter how subtle, can lead to life-changing or even life-ending consequences. While some risk factors cannot be changed, there are plenty that can be modified with help from a healthcare provider.

In our clinics at MedStar Heart & Vascular Institute, we empower women with knowledge about their personal heart health risk factors. This Heart Month, and always, talk with a primary care provider about the care you need, and follow up with a cardiologist to optimize your heart health for life.

3 Symptoms that are unique to women.

1. Subtle chest discomfort.

Despite chest pain being the most common heart attack symptom in women, many women often describe it not as crushing pain like men do, but as discomfort, pressure, squeezing, or a bandlike sensation in the chest.  

This can be attributed to conditions such as  coronary microvascular dysfunction (CMD) and coronary artery vasospasm, which tends to affect women more frequently than men.  CMD involves blockages in the smaller arteries, leading to a decrease in blood flow to the heart muscle. CMD is often misdiagnosed or overlooked because standard tests for heart disease, such as angiograms, are designed to detect blockages in the larger coronary arteries and may not detect conditions in the small vessels. 

Coronary artery vasospasm, which is a temporary, intense narrowing of a coronary artery due to the squeezing down of the muscle lining of the artery can cause a MINOCA heart attack—myocardial infarction with nonobstructive coronary arteries. MINOCA is often missed or misdiagnosed as non-cardiac chest pain due to the lack of visible blockages on angiograms, leading to a delay in appropriate treatment and potential long-term heart damage. 

MedStar Health has been a leader in the development and implementation of the Coroventis CoroFlow Cardiovascular system, an advanced technology that shows us the tiny arteries involved with CMD. This system helps us spot microvascular blockages to treat or prevent a heart attack. 

Related reading: Heart Attack with No Symptoms: The Danger of Silent MI

2. Discomfort in the jaw, arms, and upper body.

Jaw, shoulder, or upper back pain may seem far from the heart, but women who had heart attacks frequently report these symptoms. Discomfort can radiate from the heart, making it seem like the pain is coming from elsewhere in the body.

The same goes for indigestion. If you have burning fullness in the chest, nausea, and vomiting that doesn’t have a clear cause, see a doctor right away. Gastrointestinal symptoms are nearly twice as common in women than in men who are having a heart attack.

3. Shortness of breath, lightheadedness, or fatigue.

When the body is poorly oxygenated due to narrowed blood vessels or a blockage, you may feel lightheaded, dizzy, or short of breath. This could be as subtle as just feeling less energized than a few weeks ago to as extreme as feeling fatigued and sluggish.

Talk with a doctor if you notice these symptoms. CMD-related blockages can cause more gradual tiredness and slower onset of symptoms compared to traditional blockages. 

Related reading: Melanie’s Story: How Determination and Advanced Technology Found the Cause of Her Heart Attack.

Women’s cardiovascular risk factors.

1. Anxiety and depression

When we are stressed, adrenaline, norepinephrine, and cortisol (the stress hormone) flood the body. These chemicals dump glucose into the bloodstream, narrow the arteries, increase inflammation, and raise our blood pressure. It’s a safe and natural response in acute situations, but chronic stress can cause irregular heart rhythms and damage the heart muscle.

Related reading: The Effects of Stress on the Heart.

2. Early-age, late-age, or irregular periods.

A review of 29 research articles involving patients from around the world found that girls who got their first period at 11 or younger or at 14 or older had a higher risk of stroke or coronary heart disease in their lifetime than girls whose first period arrived at age 12-13. 

There are several possible reasons for this, though research is continuing. Early first periods are associated with obesity, high blood pressure, and a constellation of conditions called metabolic syndrome that increases heart attack and stroke risk. Later first periods result in less lifetime exposure to the hormone estrogen, which can be protective against cardiovascular disease. 

The average menstrual cycle—the time from the first day of your period to the first day of the next period—is 22-34 days. Women with shorter or longer cycles are at 19% higher risk of heart disease and 40% higher risk of atrial fibrillation, which is an irregular heart rhythm that can cause a stroke. Shorter cycles are associated with a 29% higher risk and longer cycles have an 11% increased risk of cardiovascular events such as heart attack, stroke, and heart failure.

3. Early menopause.

As I explained in Woman’s World, estrogen helps keep the blood vessels flexible. During menopause, the time of life when periods stop and fertility ceases, women have a natural decline of estrogen. Most women go through menopause between age 45 and 55. When it starts earlier, cardiovascular risk increases due to shorter lifetime exposure to estrogen. 

As estrogen declines, four risk factors can emerge:
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• Blood pressure gets higher and the arteries stiffen. 

• Cholesterol levels change: Total cholesterol goes up, bad cholesterol (LDL) increases, and good cholesterol (HDL) decreases. Cholesterol contributes to plaque to buildup in the arteries (atherosclerosis).

• Insulin resistance, when the body can’t effectively process glucose from your blood, begins or worsens, leading to prediabetes or Type 2 diabetes. Men with diabetes are twice as likely to have a heart attack, and women with diabetes are four times as likely. 

• Changes in muscle and fat. With age, women lose muscle mass and gain fat around our organs (visceral fat).

4. Pregnancy and women’s health complications.

The heart works overtime during pregnancy—your total blood volume  increases by 50%o support the fetus, which adds extra strain to your blood vessels and heart. And that is when everything is going right!

About 30% of women have an adverse pregnancy outcome, which is a pregnancy-related complication. Examples include preeclampsia (high blood pressure during or after pregnancy) or gestational diabetes. Having these complications can be a sort of crystal ball to a woman’s future heart health. Women who had preeclampsia or gestational diabetes may be at double the risk of a cardiovascular event such as heart attack or stroke later in life.

In rare cases, patients may develop spontaneous coronary artery dissection (SCAD), which is a life-threatening emergency. The exact cause of SCAD has not yet been discovered, though we know it is more common in women and is associated  with stress,  hormonal changes, inflammation, or genetics.

Having other women’s health conditions can increase the lifelong risks of cardiovascular disease, possibly due to hormone changes and associated stress or anxiety caused by the condition. Some of these include:
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• Infertility with need for in vitro fertilization

• Repeated pregnancy loss  

• Polycystic ovarian syndrome

• Endometriosis

Experts in the MedStar Health Cardio-Obstetrics team work with patients to identify and control cardiovascular risk factors before, during, and after pregnancy. While not all conditions can be prevented, early detection and personalized treatment can reduce the risk of heart complications later in life.

Related reading: Cardio-Obstetrics: Supporting Heart Health Through Pregnancy and Beyond

5. Autoimmune conditions.

Women are four times more likely than men to develop autoimmune diseases, in which the body misidentifies its own tissues or cells as an infection or intruder. This could be due to antibodies (immune system proteins) that develop in the blood throughout a woman’s lifetime.

Lupus and rheumatoid arthritis have been associated with increased cardiovascular risk. The body’s constant infighting increases inflammation, which can escalate the impacts of high blood pressure and high cholesterol over time.

Don’t delay heart care.

Women tend not to put our own health first. But with the heart, time is muscle—waiting too long to intervene increases the risk of significant damage to the heart.

Your heart is the powerhouse of your overall health. Talk with a health care provider about the screenings and exams you need based on your personal and family health history. When you prioritize your health, you pave the way for a longer, higher-quality life. You gain valuable time and energy to do what you enjoy with the people you love.