When you picture a heart attack in action, the first image that comes to mind might be someone doubled over, clutching their chest. But what if we told you the signs in women can be drastically different? Unfortunately, the medical system has yet to catch up with women twice as likely to die from their heart attack than their male counterparts. Here's why, plus the signs that could save your life.

Every year, more women die from heart disease than from all cancers combined. So why are we radio silent on it? For much of our recent history, medical professionals and the media have falsely presumed this deadly condition mostly affects men – but this isn't the case, and rates are only growing on both fronts. Cardiovascular disease, including heart attacks, is the leading cause of death in women globally, accounting for about 1 in 3 female deaths – but women are more likely to be underdiagnosed and undertreated for heart disease compared to men, and studies have shown they’re also less likely to survive due to a delayed recognition of symptoms.

Here’s the kicker – there’s nothing really special or unusual about heart attacks in women that makes them less treatable, in fact, the symptoms are easy to recognise. It’s merely a matter of getting the word out and updating decades of misinformation and ill-informed doctors. Should be a breeze, right? Famous last words.

While heart disease has long been considered a "man's problem," the truth is that it poses a grave threat to women. Yet, the underestimation of gender-specific heart risks, coupled with the lack of awareness, has led to dire consequences for women. Cardiovascular disease encompasses a spectrum of heart issues including heart attacks, strokes, and heart failure – and while the rates of this disease are certainly high among men, women aren’t left unscathed. Quite the opposite, actually. The reason? A differing presentation of symptoms. These differences can lead to misdiagnosis or delayed treatment in women, with doctors often brushing off the symptoms women report.

While men typically experience crushing chest pain or discomfort that send alarm bells ringing for any doctor or emergency responder, women might manifest subtler signs – but it’s worth noting that men can sometimes experience these signs as well, as can women sometimes experience that elephant-sitting-on-your-chest pain, only further proving the importance of understanding these lesser-known signs of a heart attack:

Chest Pain or Discomfort: Women can experience chest pain or discomfort, but it may not always be as severe or localised as in men. The pain may be more diffuse and may not necessarily be on the left side.

Shortness of Breath: Breathlessness or difficulty breathing can occur, often without chest discomfort. It might be mistaken for a respiratory issue.

Fatigue: Unusual fatigue or weakness can be a symptom. This fatigue may be severe or come on suddenly, sometimes lasting for days.

Pain in the Jaw, Neck, Back, or Arms: Women may experience pain or discomfort in the jaw, neck, back, or one or both arms. This pain can be gradual or sudden.

Nausea or Vomiting: Some women may feel nauseated or may vomit, which could be attributed to indigestion. This symptom is more common in women than in men.

Dizziness or Fainting: Women may experience lightheadedness, dizziness, or fainting, which can be attributed to a drop in blood pressure.

Unexplained Anxiety or Sweating: Some women report feeling anxious or sweaty without an apparent cause. This one is particularly alarming when we think about how many women get told they're "just anxious." 

Certain risk factors have a stronger impact on women, including hormonal changes during menopause which can lead to decreased levels of estrogen, which has a protective effect on blood vessels. Dr Mariana Martinho, an author of the study unveiling the shocking discrepancy between male and female heart attack deaths, says menopause is a factor that needs greater consideration among doctors in order to save lives.

“Postmenopausal women had worse short- and long-term outcomes after myocardial infarction than men of similar age,” Dr Martinho wrote in a press release. “Premenopausal women had a poorer prognosis in the long-term compared with their male counterparts.”

Women with diabetes are also at a higher risk of heart disease compared to men with diabetes. Even conditions like depression and chronic stress can influence heart health more significantly in women – these are all things that need to be understood better not just by the public, but by doctors too, many of whom are failing to keep up with our growing understanding of health.

The History of Ignoring + Misinterpreting Women’s Symptoms

Historically, there has been a significant gap in understanding and recognising heart attack symptoms in women, and this has contributed to a higher mortality rate compared to men. Several factors have played a role in this disparity, including the misinterpretation of symptoms, gender bias in medical research, and the reliance on studies that predominantly used male subjects – I mean, this isn’t exactly a surprise when we consider that male subjects were used for period pain research? Need we say more? But these exclusions have drastic consequences for women, leading to a lack of understanding of how diseases, including cardiovascular conditions, manifest in women.

In 1990, cardiologist Dr Nieca Goldberg told CNN she believed a female patient had experienced a heart attack, despite having been taught that heart disease was generally a male condition. She had to push other doctors to listen as they insisted the patient was just “stressed out." Sound familiar? But Dr Goldberg discovered 99% arterial blockage known as "the widowmaker" due to its lethality - without intervention, this patient would have almost certainly died. 

“Even the terminology describing the lesion is so gendered,” Dr Goldberg told CNN, referring to the "widowmaker" term.

Cardiologist Dr Nieca Goldberg

Here's another sobering statistic – if you hadn’t already heard enough! – heart disease kills over double the amount of Aussie women than breast cancer. Yikes. What’s more, nearly 40% of women’s heart attacks end in death – despite our misunderstanding of heart disease as a “man’s disease,” it remains one of the leading causes of death among women. Yet diagnostic and treatment guidelines have been based primarily on male-centric data, leading to:

Misinterpretation of Symptoms: Traditionally, the understanding of heart attack symptoms has been based on the male experience. The classic symptom of a heart attack is often depicted as severe chest pain, which may radiate down the left arm. However, studies have shown that women may present with symptoms that differ from this traditional pattern.

Atypical Symptoms in Women: Women may experience more subtle or atypical symptoms such as shortness of breath, fatigue, nausea, or pain in the jaw, neck, back, or arms. These symptoms can be less immediately associated with heart issues and may be mistakenly attributed to other conditions.

Delayed Recognition and Treatment: Due to the misinterpretation of symptoms and the lack of awareness regarding atypical presentations in women, there has been a delay in recognising and treating heart attacks in female patients. This delay can have severe consequences, as timely intervention is crucial in improving outcomes.

Campaigns for Awareness: In recent years, there has been a growing awareness of these issues, and efforts have been made to educate both healthcare professionals and the public about the unique symptoms women may experience during a heart attack. Campaigns promoting gender-specific guidelines and increased awareness have sought to address these disparities.

Improvements in Research and Guidelines

Recognising the need for a more inclusive approach to research, there has been a push for increased representation of women in clinical trials. This has led to a better understanding of gender differences in cardiovascular health. Updated guidelines now emphasise the importance of considering atypical symptoms and risk factors specific to women. While progress has been made in addressing these disparities, there is still work to be done to ensure that healthcare providers are well-equipped to recognise and respond to heart attack symptoms in women effectively. Increased awareness, improved medical education, and ongoing research focused on gender-specific differences are crucial steps in reducing the mortality gap between men and women in the context of heart attacks. A delayed diagnosis means a delayed response, potentially impacting the effectiveness of life-saving interventions – researchers have laid out three fronts on which we need to see change:

• Education and Empowerment: When women are aware of the unique signs and symptoms of heart disease, they’re better able to advocate for their health to doctors and medical professionals. (Of course, during a heart attack where time is of the essence, dismissive doctors can be an insurmountable obstacle in the way of treatment! That’s why education and changing protocol is vital across the board.
• Medical Training: Healthcare professionals need better training to recognise gender-specific heart symptoms.
• Research Inclusivity: Clinical research must include diverse populations to understand the intricacies of heart disease in both men and women. Researchers excluding women from studies is an issue that affects women’s health in everything from mental health and heart health to brain, gut and bone health

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