Why women often don’t recognize heart attack symptoms

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Over the last 20 years, heart attack deaths have decreased across all age groups and sexes, with one exception: women over the age of 65.

“There are a lot of different reasons for this,” said Atman Shah, MD, co-director of the Cardiac Catheterization Laboratory at the University of Chicago Medicine. For starters, when a man has a heart attack, it usually looks a lot like the Hollywood heart attacks we’ve seen on screen. “Men will start getting sweaty. There will be pain in the left side of their chest. It may go to their jaw, and it may go to their arm,” Shah said. “When we see it, we know we have to call 911.”

For women, heart attack symptoms typically look a lot different. A woman’s symptoms may include:

  • Nausea
  • Vomiting
  • Dizziness
  • Shortness of breath
  • Fatigue
  • Stomach pain

Since a woman’s symptoms tend to be more subtle, they may be associated with a non-cardiac condition, including stress and anxiety. Women may not recognize these symptoms as a threat and may get to the emergency room later than men.

“Women can be more stoic,” said Shah. “They don’t attribute those symptoms to a possible heart attack, and they’re more likely to wait at home and take longer to call 911.”

Shah said the difference in symptoms may be due to the ways men and women deposit cholesterol in the arteries.

Despite men and women experiencing different heart attack symptoms, treatment of cardiovascular disease is just as effective in both sexes.

“When women get the same treatment as men consistently, they also benefit from the same mortality reduction,” Shah said. “Women do just as well with stents as men; they do just as well with the angioplasty as men. Early, aggressive treatment is equally as important.”

So why is it that women over the age of 65 have the highest mortality rate? The answer may be surprisingly simple. According to Shah, it’s likely a generational gap.

“Women of a certain generation can still have the idea that only men have heart attacks,” Shah said, “and due to the symptoms being so mild, they don’t think they are having one.”

Educating women and primary care doctors on what to look for when it comes to heart attack symptoms is something the UChicago Medicine cardiology team takes great pride in. This includes educating women about preventive steps to reduce their risk of cardiovascular disease. Factors that increase heart attack risk for both women and men include:

  • Diabetes
  • High blood pressure
  • High cholesterol
  • Smoking
  • Family history
  • A diet high in saturated fats
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Atman P. Shah, MD

Atman P. Shah, MD, is an interventional cardiologist who specializes in minimally invasive, catheter-based techniques. He cares for patients with complex structural heart disease, including congenital heart defects, and performs catheter-based procedures to reduce the risk of stroke in patients with atrial fibrillation.

Learn more about Dr. Shah