Medically Approved

5 heart attack symptoms women shouldn’t ignore

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When you’re feeling off, it could be your body trying to tell you something. Don’t let these signs of a heart attack fly under the radar.

Jessica Migala

By Jessica Migala

You might assume that if you ever have a heart attack, you’ll just know it. Like in the movies, you’ll clutch your chest, call 911 and head to the hospital right away.

But that’s not always the case — especially if you’re a woman.

Cardiovascular disease is the leading killer of women in the United States, causing 1 in 3 deaths each year, according to the American Heart Association (AHA). What’s worse, many women experience signs and symptoms of a heart attack that are outside of the clutching-your-chest norm. And those are harder to recognize.

A nationwide survey by the Cleveland Clinic found that about half of respondents didn’t know that atypical symptoms such as pain in the back and jaw, dramatic fatigue and nausea could be signs of a heart attack in women.

“Some heart attacks are sudden and intense, but many times symptoms begin and then become more pronounced over time,” says Suzanne Steinbaum, DO. She’s a cardiologist in New York City. She's also a volunteer medical expert for the AHA’s Go Red for Women movement.

Women may also brush off their symptoms as acid reflux, the flu or normal aging, Dr. Steinbaum says.

That’s why it’s important to know exactly what symptoms to watch out for so that you can take quick action. Because that can save your heart — and your life.

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Heart attack symptom #1: Chest discomfort

This is the most common symptom people report. More than 85% of women and men experience chest pain when having a heart attack. These findings were reported in a 2018 study in Circulation.

It can feel like uncomfortable pressure, tightness or pain that lasts more than a few minutes. “The overwhelming comment I hear from patients is that their chest pain feels more like pressure than pain. It has been classically described as being like an elephant sitting on the chest,” says Dr. Steinbaum.

But chest pain isn’t the only telltale sign to watch for. The AHA notes that women may feel the discomfort lower in their chest than men do, including down in their upper abdomen. (That’s why some mistakenly think it’s acid reflux.)

In the study, women were more likely to have a cluster of 3 or more symptoms, too. These could be heart palpitations or added pain or discomfort in the jaw, neck, arms or in between the shoulder blades.

Unfortunately, women were also more likely to think that their problem was related to stress or anxiety.

Sure, life can be hectic. But chest pain isn’t normal. Dr. Steinbaum notes that in some people the pain can come on gradually. So don’t rule out chest pain just because it doesn’t fit these parameters. Call 911.

Heart attack symptom #2: Shortness of breath

It’s one thing if you set out on a hard run and feel out of breath (especially if there are hills). It’s another if you’re walking up the stairs — which you do routinely — and suddenly can’t make it up without stopping because you’re winded. Or you can’t walk to your car without gasping for air, when normally you would have been just fine.

“Exercise not only is by far the best medicine — it’s the barometer for knowing exactly how you feel,” says Dr. Steinbaum.

If a routine movement is suddenly too challenging, you can’t catch your breath during it or you experience chest discomfort, those may all be signs that something is wrong with your heart, she says.

Related reading: Can you pass this heart health quiz?

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Heart attack symptom #3: Nausea or vomiting

Riding in the back seat, having the stomach flu, eating something that shouldn’t have passed the smell test. All of these things can trigger nausea or vomiting. But feeling queasy can also point to a heart attack. “Women may dismiss these types of symptoms, as they can be caused by issues not linked to a heart attack,” says Dr. Steinbaum.

If you don’t know why you’re vomiting or struck with a bout of nausea, contact your health care team right away. As Dr. Steinbaum says: “Don’t die of doubt.”

Heart attack symptom #4: New or extreme fatigue

Vague symptoms such as fatigue are tough, right? We’re all tired from our busy days. Perhaps you think you’re feeling low on energy because you need more sleep — or maybe you skipped lunch or think you’re crashing hard from too much morning coffee.

The red flag here is when the tiredness seems out of proportion with what you’ve felt in the past, says Leslie Cho, MD. She’s a member of the American College of Cardiology’s Cardiovascular Disease in Women Committee in Cleveland.

For instance, maybe you typically feel a bit low on energy around 3 p.m., but standing up and getting a glass of water or a snack usually helps perk you up. Fine. But if you’re now over-the-top lethargic or suddenly have to lie down, that’s outside of your normal routine. Your body is trying to tell you something.

Heart attack symptom #5: No symptoms at all

Yes, some people have no signs that they’re having a heart attack. This is called “silent ischemia,” says Dr. Cho. Most people find out about silent heart attacks during an electrocardiogram, an echocardiogram or a stress test that shows that the heart isn’t getting enough blood.

The group most at risk are those who have diabetes (especially younger women with diabetes) and those who have had a heart attack before.

“Most women present with a heart attack 10 years later than men. But women who have diabetes present at a similar age as men,” Dr. Cho explains.

If you have diabetes or have had a heart attack before, you should talk to your doctor. The good news is that preventive screenings and lifestyle measures can help lower your chances of having these silent episodes in the first place.

The bottom line

It’s good to be aware of the signs and symptoms of a heart attack. But know that it’s not up to you to decide if you’re having one or not.

“If something doesn’t feel right, it’s worse than you’ve ever felt or it’s something you’ve never experienced before, you need to seek professional help,” says Dr. Cho. “Don’t be your own doctor — that’s what your health care team is for.”

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Additional sources
Stats on women and heart disease:
American Heart Association
Nationwide survey on the causes of heart attacks: Cleveland Clinic
Study on the differences in heart attack symptoms between men and women: Circulation (2018). “Sex Differences in the Presentation and Perception of Symptoms Among Young Patients With Myocardial Infarction”