11 Facts About Heart Attacks in Women

by Matt McMillen Health Writer

Time for a heart to heart: When it comes to heart attacks, men and women are not created equally. While their hearts may look the same, there are actual physiological differences that often affect symptoms when a heart attack strikes. These differences sometimes make heart attacks harder to diagnose in women. Even so, male or female, if you have a heart attack it’s always a health emergency that requires immediate medical treatment. The key is knowing what to look for, so let’s get to it.

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Women Have Some Unique Risk Factors

Being a woman means you can develop conditions that men can’t. We’re talking things like endometriosis, polycystic ovary disease, and pregnancy-related high blood pressure (HBP), all of which can bump up the odds of having a heart attack. In fact, a study at Brigham and Women’s Hospital found that women with endometriosis, a painful disorder where uterine tissue grows in other areas of the pelvis—were up to three times more likely to have a heart attack, experience chest pain, or need treatment for blocked arteries. The possible culprit? The chronic inflammation that accompanies endometriosis may also inflame the arteries.

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Common Risk Factors Are More Dangerous for Women

Both men and women can get diabetes, have HBP, or struggle with depression. Yet if you’re a woman with any of these conditions, you may be at greater risk for a heart attack than a man who has the same, according to the American Heart Association. In fact, clinical depression—twice as common in women as it is in men—doubles a woman’s heart attack risk. It’s thought that women’s range of symptoms may go untreated, either because they put their families first and don’t see a doctor, or their symptoms are wrongly diagnosed or even dismissed when they do.

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Estrogen May Be Protective—to a Point

Women tend to have heart attacks later in life than men do: The average age for a first heart attack is 72 in females and 65 in men. Experts believe women’s exposure to estrogen through most of their reproductive life provides some extra protection against heart attacks, but only until about age 50 or so. You know what happens around then … menopause. Once those hormone levels drop, the advantage goes away, says Michael Goyfman, M.D., the director of clinical cardiology at Long Island Jewish Forest Hills in Queens, NY.

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Younger Women Are Having More Heart Attacks

We know, we just said women’s higher estrogen levels may be a benefit—and in general that’s true. But according to a 2019 study published in Circulation, heart attacks are rising among younger women, and they’re especially dangerous and deadly. It’s still unclear what’s driving the increase, but researchers speculate that young women overall are less healthy today than they were 20 years ago. Young women, defined in the study as ages 35 to 54, were more likely than men to have diabetes, high blood pressure, kidney disease, and stroke—which all have connections to heart disease.

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For Men, Heart Attack Symptoms Usually Come on Fast…

Plaque buildup in the arteries can lead to heart attacks in both men and women—but how that plaque triggers one can be very different. Among men, plaque often suddenly ruptures, or breaks apart. The body’s emergency response system forms a protective blood clot. Unfortunately, that clot can block an artery that supplies blood and oxygen to your ticker, causing a heart attack. Such ruptures account for 75% of all heart attacks in men but only 55% in women.

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…and the Symptoms Are Obvious

When plaque ruptures and completely blocks an artery—again, more common in men—the symptoms are severe. Men will likely experience crushing chest pain and heaviness. “Imagine an elephant sitting on your chest,” says Dennis Bruemmer, M.D., a cardiologist at the Cleveland Clinic in Ohio. Additional, less-obvious symptoms for men include: shortness of breath; pain in other parts of the upper body like the arms, neck, and jaw; and nausea.

Women can sometimes experience some or all of these symptoms, too, adds Dr. Bruemmer. However, they often show subtler or milder signs of heart attack. More on that next.

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For Women, Heart Attacks Can Occur in Slo-Mo…

Women—especially those under 60—often experience what’s called plaque erosion. As erosion occurs, bits of plaque wear away, and smaller blood clots form in response. Unlike a sudden rupture, which causes immediate, unmistakable symptoms—like severe chest pain—this erosion takes place over time. Symptoms may come on gradually, too. This is particularly true in women who have not yet been through menopause, although it’s not yet known why. “We don’t understand this well,” Dr. Bruemmer admits.

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…and Symptoms Can Last for Weeks

Because women, especially those under 55, are less likely to have complete blockages, their symptoms may appear gradually and seem less severe than men’s. “They present with what we call atypical symptoms—vague symptoms like fatigue, nausea and vomiting,” says Dr. Bruemmer. Other symptoms in women may include: dizziness; sweating; pain in places like the jaw, either arm, shoulder, back, or stomach

He adds that it’s important to note how vague and mild symptoms in women can begin three to four weeks before a heart attack strikes.

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Women Are Less Likely to Survive a Heart Attack

More women than men die in the aftermath of a heart attack, according to a study published in Circulation. This may be because women tend to wait longer before going to the hospital, perhaps because their symptoms are vague or don’t seem life-threatening, says Dr. Goyfman. Once at the ER, they’re less likely to get the right kind of treatment because their heart attacks can be harder to diagnose, he adds. Women’s heart attacks are also more likely to be caused by blockages to small arteries, which angiograms often can’t pick up.

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Treatment After a Heart Attack Is Often Less Aggressive for Women

After surviving a heart attack, women are at greater risk for blood clots that can cause another heart attack, according to the Cleveland Clinic. Yet, for unknown reasons they’re less likely to receive medication to prevent blood clots, which may explain why women are more likely to have a second heart attack within 12 months. Women are also less likely to be referred to a cardiac rehabilitation facility for heart health education and exercise, nutrition, and stress relief guidance. Over the past 30 years, fewer than one in five women who’ve had heart attacks received cardiac rehab care.

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Both Men and Women Can Prevent Heart Attacks

Whether you’re a man or a woman, there are steps you can take to reduce risk and help prevent a heart attack. Do everything in your power to quit smoking. Get at least 150 minutes of exercise each week. Eat a nutritious, heart-healthy diet, like the Mediterranean or DASH diets. See your doctor on the regular to track HBP, high cholesterol, and high blood sugar levels. Maintain a healthy weight. “While men and women can present with different symptoms of heart attacks, they should take the same steps to prevent heart attacks in the first place,” says Dr. Goyfman.

Matt McMillen
Meet Our Writer
Matt McMillen

Matt McMillen has been a freelance health reporter since 2002. In that time he’s written about everything from acupuncture to the Zika virus. He covers breaking medical news and the latest medical studies, profiles celebrities, and crafts easy to digest overviews of medical conditions. His work has appeared, both online and in print, in The Washington Post, WebMD Magazine, Diabetes Forecast, AARP, and elsewhere.