Knowledge is Power

6 heart attack warning signs women often ignore
By Bradley Bale, MD, Amy Doneen, ARNP, and Lisa Collier Cool

Women’s heart attacks are often missed by the woman having the attack, by their family and friends, and even by the medical community. Read on to learn the early warning signs—it could make a huge difference in the life of someone you love.

Why women get misdiagnosed

Of the 435,000 American women who have heart attacks each year, 83,000 are under 65 and 35,000 are under 55. Women with heart disease, especially younger women, are far more likely to be misdiagnosed than men. One study looked at more than 10,000 patients (48 percent women) who went to the emergency room with heart attack symptoms. The study found that women younger than 55 were seven times more likely to be misdiagnosed and sent home untreated than men of the same age.

One key factor that contributes to women being misdiagnosed is the lingering myth that heart disease strikes mainly men. Many women—and even their physicians—still think that breast cancer is the leading threat to women’s health. An American Heart Association (AHA) survey found that 43 percent of women didn’t know that cardiovascular disease is the number-one killer of women, claiming 10 times more female lives each year than breast cancer (432,700 compared to 40,800). Only eight percent of primary care doctors—and 17 percent of cardiologists—knew that more women than men die from heart disease, the AHA survey found.

Heart attack symptoms aren’t always unisex. Women are less likely to experience the classic Hollywood heart attack characterized by crushing chest pain (often described as feeling like an elephant is sitting on your chest) that may radiate down the left arm. Instead women have a higher rate of “atypical” symptoms that, though they may not include chest pain, are still serious warnings that a blocked artery is cutting off blood flow to the heart.

Six warning signs of a heart attack

Every minute counts after a heart attack, so it’s vital to call 911 if you or someone you know is having any of the six warning signs listed below—with or without chest pain:

>> Shortness of breath: During a heart attack (or in some cases in the days or even weeks before the attack) 58 percent of women report panting or the inability to carry on a conversation.

>> Non-chest pain: Instead of an explosive pain in the chest, women may develop less severe pain that resides in the upper back, shoulders, neck, jaw, or arm. And the pain may be on either side of the body.

>> Unusual fatigue: In one study of female heart attack survivors, 71 percent had flu-like symptoms and unusual fatigue in the weeks before the attack. The fatigue can be so extreme that women are too tired to make their bed, lift a laptop, or walk to the mailbox.

>> Heavy sweating: Women may be suddenly drenched with sweat for no apparent reason and their faces may become pale and ashen. Unfortunately, many women dismiss this symptom as related to menopause or hormonal fluctuations.

>> Nausea or dizziness: During an attack, women often vomit or feel like they’re going to pass out. A sudden, unexplained fall can also be a warning sign.

>> Anxiety: Many women experience a feeling of impending doom or fear before a heart attack. That’s the body telling them to pay attention—and listening to that urgent inner instinct can be potentially lifesaving. In some cases, warning signs of an impeding heart attack can occur up to three years before the actual event, a study of 515 female heart attack survivors reported.

One 2005 study reported that a full 30 to 50 percent of women’s heart attack symptoms go unrecognized by emergency and medical professionals. And while you’d expect women’s cardiovascular care to have improved since then, a 2012 study involving more than 1.1 million heart attack patients reveals that women are still being misdiagnosed at far higher rates than men.

The researchers in the 2012 study also reported that among heart attack patients under age 55 who had atypical symptoms, females are less likely to seek care. And when women do go to the hospital, their symptoms often go unrecognized, causing them to miss out on potentially lifesaving treatment until it’s too late. Almost 15 percent of the women studied died in the hospital after a heart attack, compared to 10 percent of men. Younger women with no chest pain had a 20 percent higher risk of death after a heart attack than their male counterparts.

Regardless of your age, if you notice any of the six symptoms described above, it’s imperative that you demand a thorough cardiac workup. While cardiovascular disease is more common after menopause, it can and does strike younger women—even in the absence of typical risk factors.


This article is excerpted from Beat the Heart Attack Gene: The Revolutionary Plan to Prevent Heart Disease, Stroke, and Diabetes. 2014 Reprinted with permission from the publisher, Wiley General Trade, an imprint of Turner Publishing Group.


Bradley F. Bale, MD, and Amy L. Doneen, ARNP, are the authors of Beat the Heart Attack Gene and co-founders of the Bale/Doneen Method which they teach to healthcare providers. Their research on cardiovascular disease prevention has been published in many respected medical journals.

Lisa Collier Cool is a bestselling author, blogger, and winner of 19 awards for medical journalism, including the National Magazine Award for Consumer Service.