Women’s Heart Disease: Unique Symptoms and How to Manage Risk

Heart disease kills more women than all cancers combined. Yet, most women still don’t realize it’s their biggest health threat. In the U.S. alone, about 307,000 women die from heart disease every year-that’s one in five female deaths. And the worst part? Many of these deaths happen because symptoms are missed, ignored, or misdiagnosed as something else-like stress, indigestion, or aging.

What Heart Disease Looks Like in Women

When people think of a heart attack, they picture a man clutching his chest, collapsing on the sidewalk. That’s the movie version. In real life, especially for women, it rarely looks like that.

While chest pain is still the most common symptom, only about 65% of women report it during a heart attack. That means nearly half of women have a heart attack without classic chest pain at all. Instead, they feel things like:

• Unexplained, crushing fatigue that makes even simple tasks like making the bed feel impossible
• Shortness of breath during activities they used to handle easily
• Pain or pressure in the jaw, neck, shoulder, or upper back
• Nausea, vomiting, or stomach upset that feels like the flu
• Dizziness, lightheadedness, or sudden sweating

These symptoms often come on slowly-over days or even weeks. A woman might feel tired for two weeks, then notice she’s out of breath walking to the mailbox. She might wake up at 3 a.m. with jaw pain and think it’s a toothache. Or she might feel nauseous before a meeting and assume it’s food poisoning.

This is why so many women end up back home from the ER without a diagnosis. Research shows women under 55 are seven times more likely than men to be sent home with the wrong diagnosis. And when that happens, their risk of dying within a year jumps by 50%.

Why Women’s Hearts Are Different

It’s not just about symptoms. Women’s hearts and arteries are physically different. Their coronary arteries are smaller. Their heart muscle responds differently to stress. Hormones play a bigger role than most doctors realize.

One major condition that affects women far more than men is microvascular disease. This isn’t a clogged main artery like in traditional heart disease. Instead, the tiny blood vessels that feed the heart become inflamed or damaged. Symptoms? Fatigue, shortness of breath, chest tightness during stress-but no blockages show up on a standard angiogram. That’s why many women are told, “Your tests are normal,” when they’re actually having heart problems.

Another condition unique to women is spontaneous coronary artery dissection (SCAD). This is when a tear forms in a heart artery-often without warning, and often in women under 60 with no traditional risk factors like smoking or high cholesterol. SCAD is the leading cause of heart attacks in pregnant women and women under 50.

Then there’s Takotsubo syndrome, also called broken heart syndrome. It’s triggered by extreme emotional or physical stress-a death in the family, a divorce, even a surprise party. The heart muscle temporarily weakens, mimicking a heart attack. Women make up 90% of cases.

Hidden Risk Factors Most Women Don’t Know About

You’ve heard about high blood pressure, smoking, and obesity. Those matter. But for women, there are other risk factors that are often ignored:

• Pregnancy complications: Preeclampsia, gestational diabetes, or delivering a baby prematurely (before 37 weeks) can double or even triple your risk of heart disease later in life.
• Menopause: After menopause, estrogen drops, and the protective effect it had on the heart fades. Women’s risk of heart disease spikes after 50.
• Autoimmune diseases: Lupus, rheumatoid arthritis, and psoriasis all increase inflammation in the body-and that damages arteries over time.
• Chronic stress and depression: Women are twice as likely as men to experience depression, and mental stress triggers heart symptoms 37% more often in women than in men.
• Polycystic ovary syndrome (PCOS): Women with PCOS have higher insulin resistance, higher blood pressure, and more abdominal fat-all of which raise heart disease risk.

Even your menstrual history matters. Women who started periods early (before age 11) or went through menopause early (before 45) have a higher risk. These aren’t just personal details-they’re medical red flags.

Why Diagnosis Is So Often Delayed

There’s a deep bias in medicine that still thinks heart disease is a “man’s disease.” A 2022 study in JAMA Internal Medicine found that in 68% of emergency room cases where women had heart symptoms, doctors assumed they were anxious or emotional-rather than checking for heart problems.

Women are more likely to be told, “It’s just stress,” “You’re too young,” or “You’re probably just having hot flashes.” But these aren’t excuses-they’re missed opportunities.

And it’s not just doctors. Women themselves often downplay their symptoms. A study from the Family Heart Foundation found that women are 59% more likely than men to blame their symptoms on indigestion, muscle strain, or anxiety. That leads to an average delay of 2.3 hours before seeking help. Every minute counts. After 90 minutes without treatment, heart muscle starts dying.

What You Can Do to Protect Yourself

The good news? You don’t have to wait for a crisis. There are clear, practical steps you can take right now.

Know your body. If you’ve had unexplained fatigue for more than two weeks-especially if it’s worse than usual or comes with shortness of breath-get checked. That’s one of the most common warning signs before a heart attack in women.

Track your health history. Write down:

• When you started your period
• Any pregnancy complications
• When you went through menopause
• Any history of autoimmune disease or depression

Bring this to your doctor. It’s not just “personal info”-it’s critical cardiac risk data.

Ask for the right tests. Standard stress tests and angiograms often miss microvascular disease. Ask if you should get a Corus CAD test-a blood test that looks at gene patterns to detect heart disease in women with 88% accuracy. Or request an echocardiogram if you’ve had symptoms after emotional stress.

Find a women’s heart specialist. Hospitals with certified Women’s Cardiovascular Centers of Excellence have 25% fewer diagnostic delays for women. If you’re having symptoms, go to one. You’re 22% more likely to survive if you’re treated there.

Manage stress like your life depends on it-because it does. Practice breathing exercises, walk daily, talk to a therapist, or join a support group. Chronic stress isn’t just “in your head.” It’s damaging your heart.

What’s Changing-and What Still Needs to Change

There’s progress. In 2023, the National Heart, Lung, and Blood Institute launched the RENEW initiative, pouring $150 million into research focused on women’s heart health. The FDA approved the first diagnostic tool designed specifically for women. And 147 hospitals now have certified women’s heart programs.

But the gaps are still huge. Only 38% of participants in major heart studies are women-even though women make up over half the population. Only 34% of cardiovascular research funding targets women’s specific needs.

And the messaging? Still too focused on men. Most public health campaigns show men collapsing with chest pain. They don’t show the woman who’s been exhausted for weeks, who finally calls 911 because she couldn’t lift her grocery bag.

We need better education-for doctors, for patients, for families. We need research that doesn’t treat women as an afterthought. And we need to stop dismissing symptoms as “just anxiety.”

What to Do If You Think It’s Your Heart

If you’re experiencing any of these symptoms-especially if they’re new, unusual, or worse than normal-don’t wait. Don’t call your doctor tomorrow. Don’t text a friend. Call 911 now.

• Don’t drive yourself.
• Don’t wait to see if it goes away.
• Don’t assume it’s not serious because you’re young or healthy.

Heart disease doesn’t care if you’re busy, strong, or fit. It doesn’t care if you’ve never smoked or if you eat kale every day. It only cares if you’re alive to get help.

Final Thought: Your Heart Isn’t a Side Issue

Women are caregivers, mothers, leaders, workers, and warriors. But you can’t take care of anyone else if you’re not taking care of your own heart. This isn’t about looking good or living longer. It’s about staying alive.

You don’t need to be perfect. You don’t need to run marathons or go vegan. You just need to listen to your body-and trust it when it says something’s wrong.

Because heart disease doesn’t announce itself with a siren. It whispers. And if you don’t learn to hear it, you might never hear it again.