It often starts with a vague uneasiness—fatigue, a little nausea, or discomfort in the upper back. No dramatic chest-clutching, no sharp pain. Just a sense that something isn’t quite right. Many women brush it off as stress, acidity, or exhaustion. But what they’re actually experiencing could be a heart attack—and the delay in recognising it can be fatal.
Dr Niranjan Hiremath, Cardiac and Aortic Surgeon, Indraprastha Apollo New Delhi shares why heart attack symptoms can be so hard to spot in women.
While the world is gradually waking up to the fact that heart disease is the number one killer of women globally, a dangerous gap still exists in how symptoms are recognised and treated. Unlike men, who typically exhibit the textbook signs of a heart attack, women often experience subtler, less obvious symptoms, which makes timely diagnosis more difficult.
The gender gap in symptoms
Biology plays a significant role in this difference. In men, heart attacks usually result from blockages in the main coronary arteries. In women, however, smaller vessels—those supplying blood to the heart muscle—are more commonly affected. This condition, called microvascular disease, doesn’t always show up on standard diagnostic tests like angiograms.
Furthermore, while chest pain is still the most common symptom for both men and women, women are more likely to experience additional symptoms such as shortness of breath, jaw pain, nausea, dizziness, fatigue, or pressure in the upper abdomen. These signs are often dismissed—by women themselves or even by healthcare providers—as unrelated to the heart.
Adding to the challenge is the fact that women’s symptoms can occur during rest or sleep, unlike men, who typically experience symptoms during physical activity. This leads to a delay in both seeking and receiving treatment.
The impact of hormones and risk awareness
Before menopause, women benefit from higher levels of oestrogen, which offers a degree of protection against heart disease. However, after menopause, this protective layer fades, and the risk of cardiovascular disease rises significantly. Unfortunately, many women remain unaware of this shift and continue to believe that heart disease is primarily a “man’s problem.”
This false sense of security, combined with low awareness of atypical symptoms, results in delayed hospital visits and underreported symptoms. Women are often more focused on caring for family members than themselves, and this self-neglect contributes to poor outcomes.
Why timely action is crucial
The longer a heart attack goes untreated, the greater the damage to the heart muscle. Studies show that women are more likely to die from a heart attack than men, largely due to delays in diagnosis and treatment.
Doctors are now urging women to listen to their bodies and speak up about unusual symptoms, even if they seem mild or unrelated. Early detection and prompt treatment dramatically increase survival rates and reduce long-term complications.
It’s time for women to take their heart health seriously—by recognising the signs, seeking timely medical help, and understanding that subtle does not mean harmless. In matters of the heart, silence isn’t strength—it’s risk.