For years, heart attack symptoms were described the same way: crushing chest pain that radiates down the left arm. While that can still happen, especially in men, experts now know heart attacks can look very different in women, particularly younger females.

“Historically, the classic symptoms we associated with heart attacks were based on how men presented, but many women experience symptoms that are more subtle or nontraditional, which is why they are sometimes overlooked or mistaken for something else,” says Nebraska Medicine cardiology fellow Rocio Barriga Guzman, MD.

Research shows that women may experience different symptoms, risk factors and types of heart disease than men. Understanding these differences could help save lives.

Are heart attacks more common in men or women?

Heart attacks have historically been considered more common in men, but heart disease remains the leading cause of death for both men and women. One challenge is that women’s symptoms may not always fit the traditional picture many people expect.

“Women are often diagnosed later because their heart attack symptoms can present differently than men,” Dr. Guzman says. “Sometimes symptoms are mistaken for gastrointestinal issues, stress or anxiety instead of a heart problem.” 

How do heart attack symptoms differ in men and women?

Chest pain is still one of the most common heart attack symptoms in both men and women. However, women are more likely to experience additional symptoms, such as:

• Pain between the shoulder blades.
• Neck, jaw or tooth pain.
• Shortness of breath.
• Nausea or vomiting.
• Upset stomach or acid reflux.
• Extreme fatigue.
• Lightheadedness.
• A sudden sense of anxiety or doom. 

“The symptoms can feel vague, which is one reason heart attacks in women are sometimes missed,” Dr. Guzman says. 

Why are heart attacks in women sometimes overlooked?

According to Dr. Guzman, there are several reasons women may delay seeking care. Some women may not realize their symptoms could be heart-related, while others worry they will be dismissed or viewed as overreacting. Many women also prioritize caregiving responsibilities and avoid seeking medical attention because they do not want to disrupt work or family life.

“There is still a misconception that heart disease mostly affects men,” Dr. Guzman says. “That can prevent women from recognizing symptoms early.”

Women are also more likely to experience so-called “silent” heart attacks. Women with diabetes are especially likely to experience them. These events may cause milder or less recognizable symptoms while still causing damage to the heart.

Emerging research also suggests younger women may be more likely to experience heart attacks caused by conditions other than traditional cholesterol-related blockages.

What are female-specific risk factors for heart disease?

Dr. Guzman says certain heart and blood vessel conditions disproportionately affect women, including some pregnant and postpartum patients. Researchers are still working to better understand why these conditions occur, but hormones may play an important role.

“One of the biggest differences between men and women is their estrogen levels,” Dr. Guzman says. “Estrogen helps protect blood vessels, reduce inflammation and support healthy cholesterol levels. As estrogen levels change with age, pregnancy or menopause, cardiovascular risk may also change.”

Women who have experienced the following female-specific cardiovascular risk factors should make sure their doctors are aware of their medical history:

• Pregnancy-related complications, such as preeclampsia, eclampsia and gestational diabetes.
• Polyendocrine Metabolic Ovarian Syndrome (formerly known as Polycystic Ovary Syndrome).
• Premature menopause.
• Autoimmune conditions.

“These conditions can increase cardiovascular risk later in life,” Dr. Guzman says.

When should you seek emergency care?

Dr. Guzman says anyone experiencing possible heart attack symptoms should seek immediate medical attention. 

“Even if symptoms feel mild or unusual, it is important not to ignore them,” she says. “We would rather evaluate someone and rule out a heart attack than miss one.”

Modern tests, including electrocardiograms (EKGs) and high-sensitivity troponin blood tests, can help doctors identify heart problems earlier, even when symptoms are not classic.