Women can experience heart attack symptoms that are different from men’s. Recognizing these signs early and seeking immediate medical attention can save women’s lives. Unlike men, women often exhibit more subtle symptoms, making it crucial to understand the differences and advocate for proper care.

Why Heart Attack Symptoms Can Differ in Women

Heart disease is the leading and most preventable cause of death among women, according to the Centers for Disease Control and Prevention.[1] “More women die every year from heart disease, including heart attacks, than all cancers combined,” says Evelina Grayver, MD, a cardiologist and the director of the Women’s Heart Program at the Katz Institute for Women's Health in New York. “Yet most people still believe heart attacks are a condition that mostly affects men.” 

Heart attack symptoms vary between men and women because of key biological and physiological differences. 

“A woman’s heart isn’t just a smaller version of a man’s heart,” says Dr. Grayver. “Our vessels are different, the caliber of our vessels is different, and the causes of a heart attack in a woman versus a man can also differ.”

One of the primary distinctions is the type of heart disease that leads to heart attacks. Men typically experience macrovascular disease, which is caused by large plaque blockages in the arteries. Women, on the other hand, tend to experience microvascular disease, which affects the smaller blood vessels and is more difficult to detect with standard diagnostic tools.[2]

“A cardiac angiogram might not show significant blockages in women, leading doctors to assume their symptoms are anxiety related rather than a serious cardiovascular event,” says Grayver.

There are also gender-based differences in heart structure, says Skyler St. Pierre, a Stanford University doctoral candidate who researches the mechanics of biological tissue in the Living Matter Lab in California.

“The female heart is geometrically and functionally different from the male heart,” says St. Pierre. “The female heart is one-fourth smaller, has a different microstructural architecture, beats faster, has a lower blood pressure, and has higher contractile strains than the male heart.”

Additionally, hormonal differences can play a role in heart attack symptoms. For instance, estrogen has cardioprotective effects, but after menopause, estrogen withdrawal leaves women twice as likely to develop ischemic heart disease than men.Ischemic heart disease, also known as coronary artery disease, is marked by the narrowing or blockage of the arteries that supply blood to the heart. While normal levels of estrogen relax these arteries and support healthy blood flow, the sharp decline in estrogen that comes with menopause can allow for their constriction.