Here’s Why Heart Attack Symptoms Can Be So Hard to Spot in Women

Women’s heart attack symptoms fly under the radar all too often. And a lot of that has to do with our own assumptions about what a heart attack actually looks like.

For example, do a quick Google image search of the phrase “heart attack” and you’ll probably see an older man in his 50s or 60s, hand on his chest, clearly in severe pain. That’s a somewhat fair depiction, given that men are at greater risk of heart attack than women, and that the most common symptom of a heart attack is chest pain or discomfort, according to the American Heart Association (AHA). But that generalization can obscure the reality that heart disease is the leading cause of death for both men and women in the United States, according to the Centers for Disease Control and Prevention (CDC)—and that there can be other symptoms of heart attacks besides chest pain, especially in women. Let’s get to the truth about heart attack symptoms in women.

Let’s talk about the causes and symptoms of a heart attack.

Although heart attacks can happen the same way in men and women, they can sometimes look different. A heart attack, or myocardial infarction, usually occurs when a blood clot in one of the coronary arteries cuts off or seriously restricts the flow of blood and oxygen into the heart, the U.S. National Library of Medicine explains. This can happen when fatty plaque builds up inside an artery, narrowing the passageway into the heart. If the plaque in that artery breaks open, a blood clot forms, restricting or stopping the flow of blood into the heart. The heart cells that are deprived of oxygen start to die, which leads to a heart attack.

The most common sign of a heart attack, in both men and women, is pain or discomfort in the middle or left side of the chest, which can range from mild to intense and last several minutes or come and go, the National Heart, Lung, and Blood Institute (NHLBI) explains.

But women are also more likely to have less expected signs of a heart attack, according to the NHLBI. (Sometimes these are called atypical or nontraditional heart attack symptoms.) These include heartburn, indigestion, nausea, vomiting, shortness of breath, extreme fatigue, and pain in the back, arms, neck, throat, or jaw. Lightheadedness and breaking out in a cold sweat are also potential symptoms, the AHA says. Women are even more likely than men to have no obvious symptoms at all, which is called a silent heart attack, according to the Office on Women’s Health. (Doctors can tell that you had a silent heart attack in the last few days to months using an electrocardiogram test.)

“We don’t really know exactly why women [with heart attacks] present differently than men,” Heba Wassif, M.D., M.P.H., a cardiologist at the Cleveland Clinic, tells SELF. According to a 2016 statement from the AHA, this is a complex and understudied issue. (And, as Dr. Wassif points out, the mere fact that these symptoms are sometimes labeled atypical may perpetuate our overlooking of them.)

Scientists believe it has to do, at least in part, with biological differences in how heart disease tends to develop in men and women—like the characteristics of the plaque, the arteries where it tends to form, and the pathophysiological mechanisms or causes underlying the heart attack, according to the AHA statement.

Here’s why it’s easy to miss women’s heart attack symptoms.

“It’s a combination of factors that contribute to this,” Jacqueline Tamis-Holland, M.D., a cardiologist at Mount Sinai Morningside at Mount Sinai, tells SELF. Underpinning nearly all of them is a lack of awareness of heart health as an important issue for women. “People are understanding and recognizing these things more now” thanks to public awareness campaigns, Dr. Tamis-Holland says. “But I think [there are] some residual [stereotypes].” Although awareness has increased over the past few decades, only 56 percent of women know that heart disease is the number one cause of death for women overall, according to the CDC.

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