Symptoms of Heart Attacks in Women

While chest pain is the most common symptom of a heart attack in men and women, there are distinct symptom differences between the sexes. Females are more likely to experience a variety of other symptoms, like shortness of breath, nausea or vomiting, and back or jaw pain, than males.

Heart disease, which includes heart attacks, is the number one cause of death for women in the United States (US). Know the following heart attack signs and symptoms in women, and call 9-1-1 if you or someone you know has one or more of the following symptoms.

Frequent Symptoms

The most common symptom of a heart attack is chest pressure or pain, but the kind of pressure or pain women experience can be different than what men describe. Females are more likely to experience the other common and less common signs than males. In addition, women may experience more subtle symptoms, and these symptoms can occur with or without chest pain.

Chest Pain or Discomfort

Any acute chest pain or pressure, such as the classic "feeling like you have an elephant standing on your chest" deserves prompt attention. The pain or discomfort can be subtle or strong, last a few minutes, or come and go.

Males usually describe their chest pain as crushing or intense pressure. In females, however, it may feel more subtle, like uncomfortable pressure, squeezing, or fullness.

Upper Back, Neck, and Jaw Pain

Pain in the neck, upper back, jaw, teeth, one or both arms, and shoulder blades is a frequent symptom of a heart attack in women. Upper back pain is often described as pressure or a squeezing feeling around the shoulder blades.

"This is called 'radiating' pain and is due to the fact that the heart has many fewer nerve endings than, say, the fingertip, where pain will be localized," Sharonne Hayes, MD, founder of the Women's Heart Clinic and a cardiologist at the Mayo Clinic in Rochester, Minn., told Health. "When the heart is being injured, pain can be felt in other areas."

Generally, though, pain related to a heart attack is confined to the upper body.

Nausea or Vomiting

Females are twice as likely as males to experience nausea, vomiting, or indigestion-like symptoms, such as heartburn, while having a heart attack. "Unless they're also having chest pain, many women write it off as something they ate when they should be calling 9-1-1," added Dr. Hayes.

When heart cells get injured or die, as they do during a heart attack, they release chemicals that stimulate the nervous system. This stimulation can cause nausea and vomiting.

Shortness of Breath

"Although men also have this symptom, women are more likely to have shortness of breath or trouble breathing, even without concurrent chest pain," said Dr. Hayes. The difficulty breathing is usually sudden and may come on in the absence of exertion.

The shortness of breath happens when the blood going from your lungs to your heart leaks back into the lungs because your heart isn't pumping blood as it should.

Rare Symptoms

A variety of heart attack symptoms can happen in women. Additionally, more unique combinations of symptoms happen to women, making it more difficult to diagnose a heart attack in women than in men. These symptoms can happen with or without chest pain. Some less common symptoms include:

• Cold sweats: Be wary if you suddenly break out in a cold sweat, especially if you're sure you're not going through menopause or this is an uncommon experience for you.
• Dizziness or lightheadedness
• Fatigue or weakness

Is It a Heart Attack, Heartburn, or Indigestion?

Additional rare symptoms of a heart attack may include heartburn or indigestion. Sometimes, it may be tricky to tell which is which, though. When in doubt, call 9-1-1.

Heartburn happens when your stomach acids travel up into your esophagus—the tube that carries food from your mouth to your stomach. This causes a feeling of chest burning or pain that can spread to your upper back, throat, and jaw.

Indigestion, while you may hear it used interchangeably for heartburn, is different from heartburn. Indigestion is an uncomfortable full feeling in the upper abdomen area that can include pain, burning, and bloating. It can be mistaken for heartburn because this feeling can happen right under the rib cage, You can have indigestion and heartburn at the same time.

The chest pain signaling a heart attack usually isn't a burning feeling. It's in the center of the chest and more of an uncomfortable pressure or fullness or stabbing pain rather than a burning sensation. This kind of chest pain can last a few minutes or go away and come back.

Why Are There Sex Differences in Symptoms?

The biggest factor in the symptom differences between females and males seems to be estrogen—a hormone responsible for female reproductive organs and sexual characteristics. One of the effects estrogen has on the body is protective effects on the cardiovascular system. Estrogen:

• Increases high-density lipoproteins (HDL)—the "bad" cholesterol
• Increases triglyceride levels
• Decreases low-density lipoproteins (LDL)—the "good" cholesterol
• Decreases total plasma cholesterol 

In general, women have heart attacks at an older age than men, which corresponds with menopause—a normal point in time that is 12 months after a menstruating person's last period—occurring later in life.

One of the most obvious signs a menstruator is approaching menopause is a drop in the level of estrogen. The loss of estrogen during menopause increases a person's risk for heart disease. Females receiving estrogen replacement therapy to treat menopause symptoms decrease their risk of heart attack by 50%.

High blood pressure, which increases everyone's risk of heart disease and stroke, often goes undiagnosed in women. Pregnant people having high blood pressure during pregnancy double their risk of developing heart disease compared to pregnant people who don't have high blood pressure during their pregnancy.

Other sex-specific reasons for symptom differences may include:

• Gestational diabetes
• Giving birth prematurely
• Having a first period before age 11
• Having menopause before age 40
• Hypertension during pregnancy
• Polycystic ovary syndrome (PCOS)
  

When to See a Healthcare Provider

If you or someone else is having any symptoms of a heart attack, call 9-1-1 immediately. Even if you think it might be heartburn or indigestion, when in doubt, seek medical attention right away.

A Quick Review

The signs of a heart attack in women may not be as obvious as the classic chest pain symptoms men experience. Women tend to have more varied and subtle symptoms. Know the common and rare symptoms so you can recognize if you or someone else may be having a heart attack.

Call 9-1-1 right away if you suspect a heart attack.