Heart disease is a top killer of women, but heart attack symptoms are different than in men. Here are the top signs to look for.
Women aren’t men
There’s a big disconnect between what women think a heart attack would feel like—excruciating chest pain—and what it actually does feel like. As Jean McSweeney, RN, PhD, professor and associate dean for research at the University of Arkansas for Medical Sciences College of Nursing, in Little Rock, Arkansas, points out: “Other than the reproductive system, the cardiovascular system has the most differences between genders.” So it’s to be expected that the symptoms—while sometimes shared with men in a general sense—can also be experienced differently. After all, “we have much smaller vessels in our heart,” says Dr. McSweeney, who was among the first to zero in on women’s heart attack symptoms in a 2003 study, published in the journal Circulation. “And we’re constructed differently.”
When a woman’s main arteries are blocked, she’ll often experience a constellation of signs, including chest pain, pressure, or tightness, along with multiple non-chest symptoms, says Judith Hilevi Lichtman, PhD, MPH, department chair and associate professor of epidemiology at the Yale School of Public Health. What’s more, not every woman experiences the same symptoms, and the symptoms don’t necessarily happen all at once. We spoke with experts and women heart-attack survivors about what exactly some of those symptoms might be and what they actually feel like. Here are a few that surprised us most.
A funky-feeling arm
“I felt like my arm was asleep,” says Tara Robinson, a school counselor, who, incredibly, survived three heart attacks in one week at the age of 40. For the first two, the feeling would emerge for a couple of minutes and then go away. By the time she arrived at the hospital, the symptoms were gone and she was sent back home without treatment. “I thought maybe I was working out too hard at the gym or I slept on it wrong,” she says. By the time the third heart attack struck, that feeling was much more intense and persistent, and impossible to ignore.
Another heart attack survivor, Lilly Rocha described her arm as feeling “sore”—a part of a general soreness experienced in her entire upper left side, along with her jaw and chest. At the time, she was 37 and a corporate vice president who organized international events; she’d jet-set from country to country on a regular basis—so naturally, she attributed it to the stress of travel. It wasn’t until a co-worker (who had himself experienced a heart attack) insisted on taking her to a hospital did she realize the shocking truth: She just had a heart attack.
A really sore jaw
Along with arm issues, fatigue, and shortness of breath, jaw problems often emerge months before an attack and then intensify during the actual event. Robinson, an American Heart Association Go Red for Women spokesperson, described it as “like the way your mouth feels after you’ve come home from the dentist and the Novocaine hasn’t quite worn off.” As with the arm, the jaw also acts up because of what doctors call “referred” pain, explains Suzanne Steinbaum, DO, a New York City cardiologist and author of Suzanne Steinbaum’s Heart Book: Every Woman’s Guide to a Heart Healthy Life. “That pain comes from the heart,” she says. Dr. McSweeney recalls a patient who first complained about her jaw to her dentist, and was given treatment for TMJ. When that didn’t help, her wisdom tooth was removed. Of course, the pain only got worse— until she ended up in the hospital with a heart attack and was finally properly treated.
Nausea and vomiting
In a 2018 Circulation study that examined women and men who experienced a heart attack before age 55, two-thirds of women said they’d experienced epigastric (upper-abdominal) issues, such as indigestion, nausea or stomach pain, notes Dr. Lichtman, the article’s lead author. Only half the men reported similar problems. As Robinson describes that day she was rushed to the hospital with her third heart attack: “I wanted to vomit so badly.” After treatment, she adopted lifestyle changes that included eating a heart-healthy diet—here’s a good guide. She now helps lead other patients in living healthier.
Shortness of breath
This can catch you by surprise while you’re in the middle of running a meeting at work, doing household chores, or even while you’re lying down. An early symptom of a heart condition can be the need to prop yourself up in bed in order to breathe better. “You feel out of breath because when your arteries are blocked, there is not enough oxygen being delivered throughout the body,” explains Dr. Steinbaum. “If the heart has been damaged or a heart attack is happening, the heart may not have the ability to push the blood forward and this can cause fluid back up into the lungs.”
Extreme fatigue
According to Dr. Steinbaum, “Women tend to dismiss symptoms because we are used to feeling uncomfortable on a monthly basis. The key to knowing when to get checked is to assess whether the things that you do every day and are normal for you suddenly become difficult, or you get symptoms while you are trying to do them.” Robinson remembers having to crawl back to her bedroom after cleaning her shower; she felt weak and wanted to take a nap.
Dr. Mcsweeney tells of one patient who reported that she was so tired, she could only make one side of the bed. She needed to rest before making the other. “It’s not this pronounced in every woman,” says Dr. McSweeney, the lead author of the American Heart Association’s Scientific Statement on women and heart disease. But if the fatigue gets progressively worse, or you don’t feel better after you’ve slept, then you should see your doctor.
When Rocha (who is also a Go Red for Women spokesperson) was hit with episodes of extreme fatigue, she blamed it on her hectic travel schedule. By the time she arrived at the hospital, where she waited and waited to be seen—no one suspected she was having a heart attack—the fatigue and feelings on the left side of her body became so overwhelming, she couldn’t move or talk. “I felt like I was going to pass out,” she says. Fortunately, she received treatment before it was too late. She now owns her own company in order to have control over the work-life balance, and she helps others learn about the importance of knowing your heart disease risk factors.
Upper-back pain
Robinson reports that her back issue was the only symptom that she’d describe as actually painful. “It felt as if it was behind my heart,” she says. Other women have described it as a sharp pain between the shoulder blades, which intensified at the time of the heart attack.
An odd feeling in the chest
Women don’t necessarily describe it as “chest pain”—much less a “Call 911!” kind of pain. “There isn’t just one way to describe chest pain and women often describe it as ‘chest tightness’ or ‘chest pressure,’ ” says Dr. Lichtman, who also points out that women may not associate their symptoms with a heart attack because of other non-chest symptoms, like fatigue, muscle pain, or stress. Rocha felt a “strong tingling sensation—almost like electricity was shooting out of my chest.” What’s more, she says, it would come and go, and, in the beginning, would last two or three minutes at a time. About six months before her actual heart attack, she went to her primary care physician (who was also her ob-gyn) because she was convinced it was breast cancer. The doctor did a breast exam, found nothing, and sent her home. Rocha eventually noticed that her entire left side—her chest, her jaw, her arm—just felt “weird.”
Flu-like symptoms
“Women might say, ‘I’m so tired. I must have a virus,'” says Dr. Steinbaum. They might convince themselves that all they’ve got are flu symptoms, many of which resemble the conditions above, including body aches, fatigue, and nausea. But if there’s anything about the sensations that seems different or more intense than anything you’ve ever felt before, get it checked out. While they may turn out not to be symptoms of a heart condition or precursors to a heart attack, you’re better off not ruling out the possibility—even if you’re under 55 and especially if you have a family history of early-onset heart disease. If you have even the slightest question you might be having a heart attack, call 911.
