Heart attacks in women: Why symptoms are different, danger signs to watch, and how to protect yourself

Heart disease is often seen as a man’s issue, but it silently takes a devastating toll on women.

Despite being the leading cause of death among women, impacting one in five, heart disease continues to fly under the radar in women’s health conversations. Even more alarming: Only about half of women are aware that it's their number one health threat, according to the US Centres for Disease Control and Prevention.

This lack of awareness is dangerous. Women don’t just face the same risks as men, they experience heart disease differently. With fluctuating hormones, pregnancy-related risks, and symptoms that often present in less obvious ways, women’s heart health requires specific attention—and it's long overdue.

For starters, women tend to have smaller hearts and narrower arteries compared to men. And that seemingly minor anatomical detail carries major consequences. As the doctors explain, women are more likely to develop heart disease in the smaller blood vessels of the heart, a condition known as microvascular disease. These tiny vessels don’t show up as easily on standard diagnostic tests like angiograms, which are designed to detect blockages in larger arteries. That means heart disease in women can be harder to spot, more likely to be misdiagnosed, and often treated too late.

According to researchers in a 2017 review, women from the age of 18 to 55 have a higher rate of certain medical conditions that may increase their risk of a heart attack. Some of these conditions include chronic obstructive pulmonary disease (COPD), kidney failure, autoimmune diseases, cancer, and mental health disorders.

In addition to these, certain risk factors common to both men and women tend to affect women differently. For example, high blood pressure in women may develop during pregnancy or as a side effect of birth control pills. Similarly, while estrogen offers protection against high cholesterol, its levels decline after menopause, increasing risk.

All these differences are closely linked to the hormonal changes and fluctuations women experience throughout their lives.

Estrogen, which plays a key protective role in cardiovascular health, begins to decrease during menopause, leading to higher risks of high blood pressure, arterial stiffness, and plaque buildup. Pregnancy-related conditions such as preeclampsia and gestational diabetes can also raise a woman’s long-term risk of heart disease.

There are medical conditions that can take shape during pregnancy, which influence the health of the heart during the pregnancy and later in life. This could include common conditions such as gestational diabetes and high blood pressure.

During menstruation, estrogen dips, while the stress hormones rise. This can lead to a faster heart rate, putting extra strain on the heart. Depression can further compound this stress, as Harjit Bahia, founder and CEO of UK-based Longevity, and the co-founder of Dubai-based ZOI-ME had told Gulf News.

There is a wide range of variables in the case for women, say Bahia. There are medical conditions that could even emerge during pregnancy, which influence the health of the heart during the pregnancy and later in life. This could include common conditions such as gestational diabetes and high blood pressure.

As the estrogen levels lower, the blood vessel walls become stiffer and more prone to inflammation. This accelerates plaque buildup and increases the risk of blockages that can trigger heart attacks.

As Brajesh Mittal, Consultant Interventional Cardiology, Al Safa – Medcare Hospital explains, after menopause, women gain more visceral fat. "Their arteries grow thicker and becomes rigid, rendering them more susceptible to diseases. Menopause-related hot flashes and night sweats have been linked to an increased risk of high blood pressure and other cardiovascular risks," he explains.

Women who go through the natural menopause later in life are less likely to develop cardiovascular illnesses, as he says. Poor cardiovascular health throughout the reproductive years, and possibly genetics are all factors that may contribute to an early onset of menopause.

A lot comes down to estrogen, which acts as a cardiovascular guard for women. It declines as they age, explains Bahia. The hormone plays a key role in navigating heart health for women, as it helps the tissues throughout the body stay supple and flexible. It contributes to increasing blood flow and keep blood pressure under control. 

Prior to menopause, the estrogen increases the HDL (good) cholesterol and decreases the LDL or bad cholesterol.

However, the levels start decreasing after the age of 36, says Bahia. As the estrogen levels lower, the blood vessel walls become stiffer and more prone to inflammation. This accelerates plaque buildup and increases the risk of blockages that can trigger heart attacks.

Large scale studies like the US-based Study of Women’s Health Across the Nation (SWAN) show that during the menopause transition there are significant changes to cardiovascular health. While the HDL decreases and LDL increases, blood lipids or fats increase, too. There’s also a protein in blood plasma called fibrinogen, which is linked with heart disease and stroke, increases, says the study.

Moreover, during the reproductive years, women who gain weight tend to collect fat around the hips and thighs. This does not pose a risk to heart health, at the time. However, after menopause, more fat is distributed in the abdomen and around the heart, and this visceral fat is linked with CVD or cardiovascular disease.

The classic symptom that everyone knows is shooting pain up and down in your left arm. However, for women it’s a lot trickier to diagnose. 

In the case of women, they have rather ‘non-classic’ symptoms, which include fatigue, nausea, and abdominal discomfort. They have pain along the back as well as the jaw. These are all linked to cardiovascular trouble in women; the warning signs of a heart attack. In fact, there have been some cases where women have reported fatigue and disturbed sleep patterns, sometimes as much as a month before a heart attack.

There are many subtle symptoms. You just need to pay close attention to your body and don’t wait to seek help.

Women have reported many different kinds of symptoms during a heart attack.

Here are the possible symptoms, as explained by Cleveland Clinic, Abu Dhabi.

Women may also have other symptoms like:

The most prevalent type of heart disease, and the main cause of mortality for women, is caused by plaque in the walls of the arteries that transport blood to your heart and other parts of your body, which is typically diagnosed in women over 50, according to Mittal. 

Heart diseases are an umbrella term that encompasses many cardio-vascular conditions. The common culprit is Coronary Heart Disease (CAD), which blocks or narrows the heart arteries with plaques that are built from cholesterol deposits. This contributes to heart attacks and strokes. The leading cause behind CAD is due to unhealthy lifestyle habits, that include unmitigated stress levels, poor maintenance of weight, and high cholesterol, she says.

While CAD is harmful enough, there are other kind of heart diseases, that include heart rhythm abnormalities. In the case of atrial fibrillation, the heart beats irregularly, which results in blood clots, complications like stroke and heart failure. Heart failure is considered a different kind of disease altogether; it is a consequence of a damaged and weakened heart, explain the experts. There are a wide range of reasons behind heart failures, including high blood pressure, viral or bacterial infections.

For starters, be aware. You need to be able to manage existing medical conditions that increase the risk of heart disease, and that includes blood pressure. You also need to keep a track on diabetes as well as high cholesterol. Another risk factor is diabetes. Diabetes elevates the risk of heart disease in women more than it does in men, perhaps because women with diabetes more often have added risk factors, such as obesity, hypertension, and high cholesterol.

Here’s what you can do:

Be more active: Make sure that you get at least 30 minutes of moderate exercise, such as walking. Introduce small changes into your life, like taking the stairs, instead of the elevator.

Eat a balanced diet: Make sure that your diet includes whole grains, a variety of fruits and vegetables, nuts, poly- and monounsaturated fats, fatty fish (such as wild salmon), and limited intake of trans fats.

Reduce stress and treat depression: Find ways to manage your stress levels. Look for relaxation strategies, and make sure you get enough sleep.