8 Signs of a Heart Attack in Women Cardiologists Want You to Know

A heart attack is one of those things most people know could happen to them, but never actually think they’ll have to deal with. As a result, people often end up second-guessing themselves when signs of a heart attack do arise. Further complicating things is that heart attack symptoms in women can look slightly different from what a man might experience, making them a little easier to brush off at first.

Still, heart disease is the number one killer of women in America—it causes roughly one out of every five female deaths. That’s more than breast cancer, Alzheimer’s disease, or accidents. But there’s unfortunately still confusion over what a heart attack can look like in women.

They don’t always mimic the drama-filled portrayals you see on screens, where someone gasps and grabs their chest in pain. Heart attacks in women can present much more subtly, making it that much more important to be aware of the real signs to know.

Time matters with a heart attack, which is why it’s so crucial to act quickly if you suspect something is off. “We have a saying that ‘time is muscle,’” says Holly Andersen, M.D., attending cardiologist at the New York-Presbyterian Hospital, Weill Cornell Medical Center, and scientific advisor for Women’s Heart Alliance.

Meet the experts: Holly Andersen, M.D., attending cardiologist at the New York-Presbyterian Hospital, Weill Cornell Medical Center, and scientific advisor for Women’s Heart Alliance; Marla A. Mendelson, M.D., co-director of the Women’s Health Research Institute at Northwestern Medicine; Erin Donnelly Michos, M.D., associate director of preventive cardiology at Johns Hopkins Medicine; Amy Sarma, M.D., a cardiologist at Massachusetts General Hospital; Jennifer Wong, M.D., cardiologist and medical director of Non-Invasive Cardiology at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, CA

Combine the lack of knowledge with what a heart attack can look like for women and the subtle ways it can show up, with not wanting to believe that you could, in fact, be having a heart attack and it’s easy to see how women may end up waiting to get care. “Women more often take a wait-and-see approach—too busy to have a heart attack right now—and too many women are dying of their heart attacks,” Dr. Andersen says.

It’s possible to have a full, healthy life after a heart attack, but you need to get proper care first. Here’s what cardiologists want you to look out for.

What exactly is a heart attack?

Unlike cardiac arrest, which is when the heart suddenly stops beating, a heart attack happens when the blood flow that brings oxygen to the heart slows down or is cut off. “Essentially what’s happening is that the arteries in the heart are unable to provide sufficient blood flow to the working heart muscle, and most commonly this is due to atherosclerosis,” says Erin Donnelly Michos, M.D., associate director of preventive cardiology at Johns Hopkins Medicine. Atherosclerosis is when the arteries become narrowed due to a buildup of plaque, which is made up of fat, cholesterol, and other materials.

Although plaque naturally builds up over time, a heart attack occurs when that plaque ruptures, forming clots, says Dr. Michos. The obstruction or blockage of the arteries causes the heart muscle to begin to die. “This is why it’s an emergency, because if the heart muscle dies, it doesn’t repair itself,” says Dr. Michos.

Extreme fatigue

Being tired or sleepy is one thing, especially after a long day dealing with work, family, and other responsibilities, but being so overwhelmed by exhaustion that you can barely move—especially when combined with muscle weakness and/or any of the other symptoms on this list—may be a warning sign of a heart attack. In fact, one study found that 70% of women who experienced a heart attack had felt unusual fatigue, making it the most common symptom, followed by sleep disturbance and shortness of breath.

Indigestion

It may sound surprising, but a heart attack can present as feeling like you ate something that really didn’t agree with you. Blame this on the heart’s position in your body: It sits on top of the stomach, so a burning sensation in your chest area might feel like simple indigestion. “We still see women staying home because they think they have indigestion and are treating themselves with antacids,” says Marla A. Mendelson, M.D., co-director of the Women’s Health Research Institute at Northwestern Medicine. So if you’re experiencing indigestion that feels extremely intense, lasts longer than usual, and doesn’t respond to antacids, get to a doctor right away.

Jaw and back pain

When there is reduced blood flow to the heart, the pain can radiate out from your chest and up to your jaw or back—it can even feel like a toothache. Everyone perceives pain differently, so you may feel it in a different spot than someone else, says Dr. Mendelson.

Heartburn

Just as a heart attack can feel like indigestion, for some people it may be mistaken for heartburn—and vice versa. “The heart sits right on top of the esophagus in the stomach, so sometimes heartburn can feel like a heart attack, and a heart attack can feel like heartburn,” says Dr. Michos. If you’re feeling heartburn, try to rest and see if the pain dissipates. “If the discomfort came on suddenly, you’ve never had it before, it lasts longer than five to seven minutes, and it’s not going away with sitting and resting, and this is a new thing, then this is how a heart attack presents,” says Dr. Michos.

Shortness of breath

Shortness of breath after a spin on a stationary bike or a jog is normal. But if you experience shortness of breath when you’re just sitting on the couch or if you’re unable to make it up the stairs you use every day, that could be a sign that something more serious is going on in your heart.

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Even if that shortness of breath isn’t accompanied by chest pain, it could still signify a heart attack. “I always tell patients that if they think that something is wrong, they should seek immediate medical attention, as everyone experiences a heart attack differently and the absence of chest pain does not mean that it’s not your heart,” says Amy Sarma, M.D., a cardiologist at Massachusetts General Hospital.

Left arm pain

One of the more well-known signs of a heart attack, sudden pain in the left arm is similar to jaw and back pain, because your brain can’t decipher where the pain is coming from (in fact, you can feel the pain in either arm, though left is more common). “Because the nerve endings all come into the spinal column at the same place—from the upper arm, from the chest—the brain can’t pick out that it’s actually happening in the heart,” says Dr. Mendelson. “If you prick your finger, you know exactly where you’re poking your finger, but you don’t have that in the chest.”

Nausea

Because the heart sits on top of the stomach, a heart attack may cause nausea, along with other symptoms of an illness, such as feeling clammy, dizzy, and lightheaded. “The heart’s your major, vital organ, and it’s not getting enough blood flow, and the heart muscle’s dying, and people feel incredibly sick,” says Dr. Michos.

Chest pain

This is the most notorious sign of a heart attack: the feeling of an elephant sitting on your chest, or a feeling of sudden tightness near your heart. “It can feel like pressure, squeezing, or tightness in the chest,” says Dr. Michos. “That’s the typical presentation.” If you’re experiencing this, it’s important to get to a medical professional right away.

To be fair, there is some overlap. “Chest pain or discomfort remains the most common heart-attack symptom in both women and men,” says Jennifer Wong, M.D., cardiologist and medical director of Non-Invasive Cardiology at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, CA.

However, women are a little more likely to experience the symptoms we named above, she says. “Differences in age at presentation, underlying health conditions, and the way coronary disease develops, including a greater role for small-vessel disease or other nontraditional mechanisms in some women, may all contribute,” Dr. Wong says.

Women tend to describe chest discomfort as “pressure,” “tightness,” or “squeezing,” instead of “pain,” which can make the symptoms easier to dismiss, according to Dr. Wong.

Waiting to seek care can also cause symptoms to change. “Delayed recognition and presentation can further affect how a heart attack appears clinically,” Dr. Wong says.

It’s possible to do everything right and still have a heart attack. But Dr. Wong stresses that there are certain things you can do to lower your risk:

• Exercise regularly
• Follow a heart-healthy diet
• Avoid tobacco
• Try to maintain a healthy weight
• Get regular, consistent sleep

“It is equally important to identify and treat risk factors including high blood pressure, high cholesterol, and diabetes before they cause symptoms,” Dr. Wong says.

Call for help immediately. “Don’t call your doctor, or your spouse—you can alert them later. Call 911,” says Dr. Andersen. When you get to the ER, tell them you think you’re having a heart attack and insist they do an EKG and blood test. If you are getting pushback, go ahead and tell them you are having chest pain, since that is the symptom that will most likely trigger action, Dr. Andersen adds.

Again, time is important here. “When blood flow is blocked, heart muscle can begin sustaining permanent injury, and certain heart attacks require an urgent procedure to reopen the artery,” Dr. Wong says. By the way, don’t feel weird about getting checked out. “It is far safer to be evaluated and learn that the symptoms were not cardiac than to wait and miss the opportunity for timely, potentially life-saving treatment,” Dr. Wong says.