How Cardiac Symptoms Are Different in Women

Symptoms often don't follow the medical textbooks

Cardiac symptoms are often not the same in women as in men. These differences, if unrecognized by women and their healthcare providers, can present a hazard to women who have heart disease.

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In standard textbooks of cardiology, much space is devoted to a description of the symptoms that typically occur with heart disease. In most cases, these "typical" symptoms turn out to be a recitation of the symptoms as they are commonly experienced by men. And while cardiologists (relying on those textbooks) may think about the symptoms of heart disease in women as being "atypical," when you consider that more women are dying of heart disease today than men, it may be statistically more correct to think of men's symptoms as the ones that are "atypical."

If you are a woman who is experiencing symptoms that you think might be related to your heart, you need to see a healthcare provider. Here are some of the ways in which the symptoms of heart disease experienced by women can differ from the symptoms experienced by men.

Angina Doesn't Necessarily Equal Chest Pain in Women

Angina is typically described as a pressure-like chest pain that may radiate to the jaw or shoulder, and in men, that's usually accurate. But many women with angina will report a hot or burning sensation, or even tenderness to touch, that may be located in the back, shoulders, arms, neck, upper abdomen, or jaw. And, often they have no actual chest discomfort at all.

Any good practitioner will think of the possibility of angina whenever a patient (of either sex) describes any sort of fleeting discomfort located anywhere above the waist that occurs during strenuous activity. Healthcare providers really shouldn't be thrown off by "atypical" descriptions.

However, because too many practitioners persist in believing that coronary artery disease is relatively uncommon in women, they may write such symptoms off as mere musculoskeletal pain, gastrointestinal discomfort, or (even less forgivably) emotional disturbances.

Angina With Normal Coronary Arteries Is More Common in Women

Furthermore, women are much more likely than men to experience angina when their coronary arteries appear completely "normal" during cardiac catheterization. These women are often told that their symptoms are due to a gastrointestinal disorder (or worse, that the symptoms are in their head), when in fact they have a significant cardiac problem.

Heart Attacks Are Different, Too

Heart attacks and acute coronary syndrome may also behave differently in women than in the typical male. While chest pain is still the main heart attack symptom in women, it's not uncommon for women having heart attacks to experience nausea, vomiting, indigestion, shortness of breath, or simply sudden and extreme fatigue—but no chest pain.

Unfortunately, it is easy for healthcare providers to attribute such symptoms to something other than the heart. Women also are more likely than men to have silent myocardial infarctions—that is, heart attacks without any acute symptoms at all, which are diagnosed only retrospectively when subsequent cardiac symptoms occur.

Women Tend to Minimize Their Symptoms

Studies now indicate that women tend to complain less about their cardiac symptoms than men, so they may fail to alert their healthcare providers to symptoms that really should not be ignored. Why they tend to do this is pure speculation. Perhaps women are more innately stoic than men, or perhaps they are tired of being told by practitioners they're just anxious. Either way, it is important that you tell your healthcare provider about ANY new or disturbing symptom that even remotely might be related to your heart.

When Should Women Seek Medical Help For Possible Cardiac Symptoms?

Given that cardiac symptoms in women may not follow the textbook, how do you know when you should seek medical help for symptoms that MIGHT be related to your heart? The rule you should follow is really pretty simple—if you think it might be related to your heart, see a practitioner. Here are some specific guidelines that might help:

Get medical help if you might be having angina and go to your healthcare provider or to the emergency room right away if you have any of the following symptoms:

  • Episodes of pain, pressure, tightness, burning or squeezing in the chest, jaw, neck, upper abdomen, shoulders, back, or arms, lasting up to five to 10 minutes
  • Unexplained episodes of shortness of breath lasting up to five to 10 minutes
  • Episodes of palpitations with lightheadedness or dizziness

Get medical help if you might be having a heart attack. Call 911 immediately if you experience any of these symptoms:

  • Unexplained shortness of breath lasting more than five to 10 minutes
  • Sudden severe nausea, vomiting, or indigestion
  • Sudden sweating for no reason
  • Sudden unexplained extreme fatigue or weakness
  • Loss of consciousness or fainting
  • Sudden, unexplained, panicky feeling of doom

Again, the key is to listen to your body and follow your instincts. If you experience a symptom that is disturbing to you in any way, which even remotely might be related to your heart, get yourself checked out. If the healthcare provider brushes you off, that's a reflection on the practitioner, and not on you. That's also a sign that it's time to get yourself a new healthcare provider, one who will actually do what is necessary to get to the bottom of your symptoms.

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  1. van der Ende MY, Juarez-Orozco LE, Waardenburg I, et al. Sex-based differences in unrecognized myocardial infarctionJ Am Heart Assoc. 2020;9(13):e015519. doi:10.1161/JAHA.119.015519

Additional Reading
  • Lehmann JB, Wehner PS, Lehmann CU, Savory LM. Gender bias in the evaluation of chest pain in the emergency department. Am J Cardiol 1996; 77:641.
  • Mosca L, Manson JE, Sutherland SE, et al. Cardiovascular disease in women: a statement for healthcare professionals from the American Heart Association. Writing Group. Circulation 1997; 96:2468.