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Key points
- Heart disease is often viewed as a "male" problem, despite it also being the leading cause of death in women.
- Women experience different symptoms than men when having heart attacks (e.g., no chest pain).
- Learning the unique symptoms of heart attacks in women can help them avoid misdiagnosis and mistreatment.
When I was 29, I had a heart attack, and the first first responders on-site assumed I was having a panic attack. Unfortunately, my experience is not unique. Many women* face incorrect diagnosis and treatment when seeking medical care for cardiac symptoms.
Despite heart disease being the number-one cause of death in both men and women in the United States [1], many health professionals continue to incorrectly view heart attacks as a “men’s issue.” Accordingly, the Women’s Heart Alliance has declared a “crisis of misdiagnosis” for women’s heart health. [2]
Women’s Heart Disease and the Problem of Misdiagnosis
Women are twice as likely as men to have their heart disease misdiagnosed as a psychiatric issue. [3] When presenting to the emergency room with heart attack symptoms, they are less likely to be viewed as emergent, less likely to be admitted, and more likely to have to wait to see a physician than men. [4] Women of color face even greater gaps in appropriate treatment. [4]
These disparities are likely caused by a lack of awareness of how women’s experiences of heart disease differ from men’s. Decades of research on heart attacks and other cardiac issues has prioritized men, missing the fact that women often do not experience the chest pain “stereotypical” of heart attacks. [5] Consequently, women are less likely to view their atypical symptoms as serious cardiac problems, and physicians are more likely to misdiagnose those symptoms even when women seek medical care. [5, 6]
To help prevent unnecessary deaths and disability, it’s important that women (and everyone) learn the unique signs of heart attacks in women.
Heart Attack Symptoms in Women
While women often do experience chest pain during heart attacks, they’re significantly more likely than men to experience a variety of other symptoms. [5, 7] Specifically, women’s heart attacks can include:
- Chest pain/discomfort that can feel like squeezing, pressure, or burning
- Feelings of indigestion or heartburn
- Extreme fatigue or generalized weakness
- Shortness of breath, dizziness, or lightheadedness
- Pain in the jaw, neck/throat, shoulder/arm, or back
- Nausea or vomiting
Many people having heart attacks also report experiencing a feeling of “doom” or dread, and that they just know that something is wrong.
If you or someone you know experiences these symptoms, it’s important that you consult with a medical doctor as soon as possible, and that you advocate for yourself by asking for your heart to be checked. Seek care even if you think you're “too young” for cardiac problems; heart disease is becoming more common in people under age 55, particularly women. [8]
Feeling Anxious?
It’s worth noting that some heart attack symptoms overlap with other medical issues, including mental health struggles like panic attacks. For people who struggle with anxiety, this overlap can feel very scary. There are differences between panic attacks and heart attacks, but even health professionals cannot always tell them apart without performing medical tests. So it’s critical to seek medical attention if you’re in doubt or experiencing concerning symptoms.
If your medical doctor determines that you and your heart are medically healthy, but you continue to struggle with panic attacks or health anxiety, there are evidence-based treatments (i.e., cognitive behavioral therapy), and Psychology Today offers a comprehensive directory of therapists who can help.
* Throughout this post, I use the term "women" to primarily refer to cisgender women. Research on the cardiac health of non-binary and trans people is highly limited. For example, it is unclear how HRT impacts the presentation of heart disease symptoms.
References
1. Ahmad, F. B., & Anderson, R. N. (2021). The leading causes of death in the US for 2020. Jama, 325(18), 1829-1830.
3. Maserejian, N. N., Link, C. L., Lutfey, K. L., Marceau, L. D., & McKinlay, J. B. (2009). Disparities in physicians' interpretations of heart disease symptoms by patient gender: results of a video vignette factorial experiment. Journal of women's health, 18(10), 1661-1667.
4. Banco, D., Chang, J., Talmor, N., Wadhera, P., Mukhopadhyay, A., Lu, X., ... & Reynolds, H. R. (2022). Sex and race differences in the evaluation and treatment of young adults presenting to the emergency department with chest pain. Journal of the American Heart Association, 11(10), e024199.
5. Mehta, L. S., Beckie, T. M., DeVon, H. A., Grines, C. L., Krumholz, H. M., Johnson, M. N., ... & Wenger, N. K. (2016). Acute myocardial infarction in women: a scientific statement from the American Heart Association. Circulation, 133(9), 916-947.
6. Weininger, D., Cordova, J. P., Wilson, E., Eslava, D. J., Alviar, C. L., Korniyenko, A., ... & Tamis-Holland, J. E. (2022). Delays to hospital presentation in women and men with ST-segment elevation myocardial infarction: a multi-center analysis of patients hospitalized in New York City. Therapeutics and Clinical Risk Management, 1-9.
7. Brush Jr, J. E., Krumholz, H. M., Greene, E. J., & Dreyer, R. P. (2020). Sex differences in symptom phenotypes among patients with acute myocardial infarction. Circulation: Cardiovascular Quality and Outcomes, 13(2), e005948.
8. Khan, S. U., Yedlapati, S. H., Lone, A. N., Khan, M. S., Wenger, N. K., Watson, K. E., ... & Michos, E. D. (2022). A comparative analysis of premature heart disease-and cancer-related mortality in women in the USA, 1999–2018. European Heart Journal-Quality of Care and Clinical Outcomes, 8(3), 315-323.
