For years, the “typical” heart attack was spoken of as a problem of middle-aged men. Today we know that the heart attack in women is common, is often diagnosed late and often presents with less clear symptoms than classic oppressive chest pain.
In this guide you will see:
- What a difference to infarction in women.
- What are the typical and atypical symptoms.
- Who is most at risk.
- What you can do to prevent and when to go to the emergency room without hesitation.
What differentiates infarction in women
Some key points:
- Heart attacks in women usually occur in the following at somewhat older ages than in men, but it can also appear in young women if there are important risk factors.
- It is more frequent that there are other problems at the same time (hypertension, diabetes, obesity, autoimmune diseases).
- There are entities such as the spontaneous coronary artery dissection and the stress cardiomyopathy (takotsubo) which are more common in women and can cause pictures similar to a heart attack.
- Symptoms may include less “spectacular” than severe oppressive pain, leading to delays in consultation.
Result: many women underestimate their symptoms or attribute them to “stress”, “tiredness” or “gastritis” until the condition is more severe.
Symptoms of infarction in women: typical and atypical
The “classic” symptoms of infarction can also appear in women:
- Intense pain or tightness in the center of the chest, which may radiate to the left arm, neck, jaw or back.
- Feeling of weight or “crushing” in the chest.
- Significant shortness of breath.
- Cold sweating, nausea, intense general malaise.
However, in women, the most frequent are atypical presentations, for example:
- Pain in upper back, jaw or neck more than in the chest.
- Chest discomfort less intense, The symptoms may be persistent, but persistent or accompanied by shortness of breath, nausea or dizziness.
- Sudden extreme fatigue (“I felt as if I had been disconnected”).
- Shortness of breath on usual exertion (climbing one or two floors, walking short distances).
- Feeling of indigestion or discomfort in the “pit of the stomach” with sweating or nausea.
The combination of unclear symptoms + the idea that “I can't have a heart attack”.” causes many women to arrive late to the emergency room.
Risk factors for myocardial infarction in women
They share many risk factors with men, but there are nuances:
- Arterial hypertension (diagnosed or not).
- Diabetes mellitus (especially poorly controlled).
- High cholesterol, particularly elevated LDL and high triglycerides.
- Smoking, even in quantities that the patient considers “few”.
- Obesity and sedentary lifestyles.
- Family history of early cardiovascular disease.
- Autoimmune diseases (lupus, rheumatoid arthritis, etc.).
- Pregnancy-related problems (preeclampsia, eclampsia, gestational diabetes) that increase future risk.
- Menopause, especially when combined with weight gain, high blood pressure and cholesterol changes.
If several of these factors accumulate, it makes sense to assess the heart proactively with a cardiological check-up.
When to ask for a cardiological evaluation
It is advisable to go beyond a “general check-up” if:
- You have over 40-45 years old, You have several risk factors (hypertension, high cholesterol, diabetes, obesity) and you have never been specifically assessed for heart disease.
- Notes chest discomfort, shortness of breath or disproportionate tiredness to the effort, even if you think it may be “stress”.
- You had problems such as preeclampsia, eclampsia or gestational diabetes and then your cardiovascular risk has not been reassessed.
- Your mom, sisters or close relatives have had heart attacks or other cardiovascular events at young ages.
A targeted assessment may include specific questioning, examination, electrocardiogram, lipid and glucose analysis, and in some cases studies such as stress test or echocardiogram, depending on your medical history.
Practical prevention for women's hearts
Prevention is built with many small decisions sustained over time. Some with proven impact:
Blood pressure
- Check it regularly, not just “when I feel bad”.
- Keep it ideally below 130/80 mmHg, if medically reasonable.
Cholesterol and triglycerides
- Know your numbers, not just “it came out a little high.”.
- In high-risk women, it may be necessary to achieve strict LDL targets (e.g, < 70 mg/dL), as explained in the LDL cholesterol: current targets and how to achieve them.
Glucose and weight
- Early detection and treatment of prediabetes or diabetes.
- Avoid progressive weight gain after pregnancy or in the transition to menopause.
Smoking
- Quitting smoking is one of the most impactful decisions.
- Even a few cigarettes a day increase the risk; there is no “safe” level.
Physical activity
- At least 150 minutes per week moderate aerobic exercise (brisk walking, cycling, swimming), adapted to your condition.
- If you have already had a cardiac event, exercise should be integrated into a program for Cardiac rehabilitation.
Stress and sleep
- Identify prolonged periods of intense stress and poor quality sleep.
- These are factors that have been associated with increased cardiovascular risk, as detailed in the article on stress, sleep and heart health.
Warning signs: when to go to the emergency room
Go to the emergency room immediately (without driving yourself) if you present:
- Pain, pressure or discomfort in the center of the chest lasting more than a few minutes or recurring, with or without irradiation to the arm, neck, jaw or back.
- Recent onset severe shortness of breath, especially if accompanied by sweating, nausea or dizziness.
- Pain in the upper abdomen or back accompanied by general malaise, nausea and cold sweat.
- Fainting, feeling faint or marked weakness.
Even if you are not sure if “it's the heart”, in the context of risk factors, it is preferable to have a urgent assessment to stay at home waiting for it to go away.
What a comprehensive heart care strategy looks like for women
In practical terms:
- Know your key numbersblood pressure, cholesterol, glucose, weight.
- Have a baseline cardiological assessment if you have risk factors or relevant antecedents.
- Maintain sustainable habits (nutrition, physical activity, sleep, stress management).
- Be attentive to new symptoms and not normalize recurrent chest discomfort, shortness of breath or extreme tiredness.
- If you have already had a cardiac event, completing a cardiac Cardiac rehabilitation and follow up.
If you identify with several risk factors or have had compatible symptoms, you can use the form of contact to schedule an assessment and define a prevention plan tailored to you.
References
- Mehta L.S. et al. Acute Myocardial Infarction in Women: A Scientific Statement From the American Heart Association.
https://www.ahajournals.org/doi/10.1161/CIR.0000000000000351 - Vogel B. et al. Sex differences in cardiovascular disease. Nature Reviews Cardiology.
https://www.nature.com/articles/s41569-021-00588-0 - 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice.
https://academic.oup.com/eurheartj/article/42/34/3227/6358710
