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How heart attacks differ in women

February 07, 2019 | UCI Health
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For many years, information on heart disease came from research that primarily studied only men. But with the increasing inclusion of women in heart disease studies and more clinical experience, doctors discovered that women and men experience heart attacks very differently.

“Half of women who have heart attacks have symptoms different from the chest pain or pressure that men typically experience,” says UCI Health cardiologist Dr. Jin Kyung Kim, who specializes in women’s heart health. “They may not have any symptoms, or they may experience heart palpitations or heightened anxiety.”

This can be especially dangerous, since neither the woman nor her doctor may recognize what’s happening. A heart attack may not be diagnosed, or the diagnosis may be delayed, costing precious treatment time.

“With a heart attack, time is muscle,” explains Kim, who also is an associate professor of medicine at UCI School of Medicine. “We have to open the artery to return blood flow to the heart as soon as possible.”

Recognizing a heart attack

For women, the symptoms are often atypical so it can be difficult to recognize when a heart attack is underway. But, generally, Kim says to pay attention to the following symptoms, especially if they’re new, sudden or severe:

  • Anxiety
  • Tightness, squeezing or dull pressure in the middle of the chest that spreads to the left arm or jaw
  • Tightness and pressure that is associated with shortness of breath, sweating or palpitations

Diagnosing a heart attack

A few other factors make it harder to diagnose heart problems in women even once a blood test reveals an attack has occurred.

One is that women tend to have smaller blood vessels and are more prone to microvasculature disease — problems with the smaller arteries that branch out from larger ones.

Blockages of these smaller vessels are often missed by angiograms. Moreover, not all cardiologists are trained to diagnose these blockages indirectly.

Less common heart diseases

Another is that women are more likely to have less common heart diseases that mimic a heart attack, such as:

  • Stress cardiomyopathy, which is not due to coronary blockage
  • Spontaneous coronary artery dissection (SCAD), which is caused by a tear in the coronary arterial wall

For example, about 90 percent of patients with stress cardiomyopathy are women, and its prognosis is much better than a typical heart attack. And SCAD can easily be missed because it occurs to women without traditional risk factors of heart disease, and may be fatal if not recognized and treated promptly.

Preventing a heart attack

Being in tune with your symptoms, knowing your family history and taking good care of yourself are the same recommendations doctors make for men and women.

There’s one exception, however: An aspirin a day is not recommended for women as it is for men.

“There is no good data showing that women will benefit from taking an aspirin a day,” Kim says. “It is not recommended except for women who are 65 or older and have had a stroke, or have a high risk of stroke or other cardiovascular disease, such as known heart disease.”

Safeguarding your cardiovascular health

Otherwise, here are tips to safeguard cardiovascular health:

“I do not recommend stress tests indiscriminately,” Kim says. “It’s best to have all the other things sorted before cardiac testing. If there’s something abnormal in the tests or in your history, then a referral to a cardiologist is a good idea.”

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