Heart attacks have long been viewed through a male-centric lens, with symptoms like chest pain, arm discomfort, and shortness of breath dominating public awareness. However, this standard narrative often sidelines how heart disease — the leading cause of death in women globally — manifests differently in female bodies.
Unlike men, women are more likely to experience what are termed “atypical” symptoms during a heart attack, leading to dangerous delays in diagnosis and treatment. How women often lack classic chest pain and show atypical signs like nausea or jaw pain, causing delays in diagnosis and treatment. Women often report subtler signs such as fatigue, nausea, lightheadedness, indigestion, or even jaw, back, or neck pain.
These symptoms are easily mistaken for less serious ailments — gastric discomfort, anxiety, or hormonal changes — and are frequently downplayed by both patients and healthcare providers. In many cases, women do not experience the “classic” crushing chest pain at all. Instead, they may feel a sense of pressure, tightness, or an unusual sense of unease. This variation can result in misdiagnoses or prolonged wait times in emergency settings, contributing to poorer outcomes and higher fatality rates.
Women typically develop heart disease about 7-10 years later than men, often after menopause, when estrogen’s protective effects begin to wane. Additionally, women are more prone to microvascular disease — a condition affecting the small arteries of the heart — which can be missed by traditional angiograms designed to detect blockages in larger vessels. MINOCA (Myocardial Infarction with Non-Obstructive Coronary Arteries) and INOCA (Ischemia with Non-Obstructive Coronary Arteries) are also common in females. Conditions like Spontaneous coronary artery dissection (SCAD), more prevalent in younger women, also complicate the clinical picture and are often underdiagnosed due to lack of awareness.
Psychosocial factors further obscure timely diagnosis. Women are more likely to attribute symptoms to stress, caregiving burnout, or anxiety, and may hesitate to seek care.
Even when they do, implicit biases in the medical system may result in their concerns being dismissed or inadequately investigated. This gender gap in cardiac care is not merely clinical — it is cultural and systemic.
Awareness is the first step toward prevention. Women should be encouraged to learn their family history, monitor blood pressure and cholesterol, adopt heart-healthy lifestyles, and prioritize cardiovascular health even if they feel otherwise well. Equally important is for clinicians to adopt a gender-informed approach to cardiac care, one that listens actively and recognizes the nuances in how symptoms present.
Closing the gender gap in heart disease isn’t just a matter of equity — it is a matter of saving lives.
