Heart attacks in women: different symptoms, differing outcomes

Heart attacks are leading causes of death in both men and women.

But even though women were thought to have some protection against heart attacks due to the effects of female hormones, like estrogen (at least until menopause), heart disease is still a killer in some women — even those under age 55, who should be “protected” by estrogen.

Also, after having a heart attack, women who survive have a 50% higher rate of dying from them as men do. Many women are also more disabled after a heart attack than their male counterparts.

The VIRGO study — Variation in Recovery: Role of Gender on Outcomes of Young AMI (Acute Myocardial Infarction=heart attack) Patients – is looking at a number of factors that may play a role in why women do more poorly than men in surviving heart attacks. It’s being run through the Yale University School of Medicine, and is funded by the National Heart, Lung and Blood Institute of the National Institutes of health. They’ve enrolled 2000 women and 1000 men (ages 18-55), who were accepted into the study just after being diagnosed with a new heart attack.

The investigators will be taking a look at issues like:

  • How women’s outcomes differ from those of men
  • How delays in presentation to a doctor/health care facility affects the risk to and outcomes of women.
  • What factors (genetic, demographic, psychosocial, behavioral) contribute to early heart disease in women.
  • Women and men-do they receive equivalent care?

Some of the results of the VIRGO study were recently released at the American Heart Association’s 2014 Quality of Care and Outcomes Research Scientific Sessions.

From one of the authors of the study:

Heart via Shutterstock

Heart via Shutterstock

“Healthcare providers should be vigilant of the fact that young women following a heart attack represent a high-risk cohort with a poorer quality of life and worse daily functioning at one year compared with similar aged men,” said first author Rachel P. Dreyer, PhD, a post-doctoral research associate in cardiovascular medicine at Yale School of Medicine in New Haven, Conn., and spokesperson for the American Heart Association. “These women appear to start off with a poor health status after their heart attack and remain poor at 12 months.”

Based on study results, more women who had early heart attacks, in this pre-menopausal group, had more underlying diseases than the males in the study.

Women had higher instances of: diabetes (39% v 27%), obesity (51% v 45%), depression (48% v 24%) and other diseases like heart failure, lung disease, stroke than males in the comparison group.

A year post-heart attack women were more likely than men to show:

  • Poorer physical functioning
  • Poorer mental functioning
  • More chest pain
  • Decreased quality of life
  • More severe physical limitations

The investigators think that women’s poorer outcomes may be due to multiple factors, such as having a preexisting illness, having fewer social supports, increased work/life responsibilities, undetected or unreported chest pain* and associated symptoms (like shortness of breath) and other factors.

The scientists are looking at how to use this information to both decrease the risk of heart attacks in this group of young women, and also to allow for better outcomes in those who still do have heart attacks.

“Although we cannot make definite conclusions based on this data, it may indicate that we need to target the pre-event setting to identify high-risk women early on,” Dreyer said. “This may necessitate public health policies, which specifically address risk factors and education in this young female group.”

The investigators are still looking at the collected data to derive as much information as possible from it. Some may be useful almost immediately and some may require further study.

*Here’s some additional information that is not from the VIRGO study. Other research has shown that some women who are having a heart attack describe the pain differently from men.

Often when men are having chest pain from a heart attack of angina they’ll use terms like “crushing,” “chest heaviness,” “feels like an elephant is sitting on my chest,” “I can’t catch my breath because of this chest pressure,” and similar phrases.

Women may feel and describe the same things, or they can also describe it differently. They may say, “this is bad indigestion,” “I’ve got gas (stomach flu),” “I’m really nauseated.”

Men, and some women, usually feel the pain/heaviness in the center of their chests, but sometimes elsewhere. Some women will complain of shoulder pain, abdominal pain, jaw pain, and not seem to experience much, if any chest pain.

Heart attack symptoms in women are often quite subtle and, consequently, make it difficult to make an accurate diagnosis. Medical professionals refer to these subtle heart attack symptoms in women as “atypical” symptoms. Women’s heart attack symptoms — particularly feelings of indigestion and stomach upset — often do not resemble classic heart attack symptoms.

Heart Attack Symptoms for Women and Men:
 Similarities and Differences

The most common symptom of a heart attack in both men and women is some type of pain, pressure or discomfort in the chest. When chest pain occurs, it usually feels like discomfort in the center of the chest that lasts for more than a few minutes. This pain may come and go.

However, especially for women, chest pain is not always severe — or even the most prominent heart attack symptom. Women are less likely than men to feel severe chest pain. Instead, women are more likely to experience “atypical” symptoms, such as:

  • Neck, shoulder, upper back or abdominal discomfort.
  • Shortness of breath.
  • Nausea or vomiting.
  • Sweating.
  • light-headedness or dizziness.
  • Unusual fatigue.

Because women may not experience severe pain during a heart attack, they — and their physicians — should take milder chest pain seriously. Further, atypical symptoms can be far less obvious to the uninformed patient and physician. Many women tend to arrive in emergency rooms after much heart damage has already occurred because their symptoms are not those typically associated with a heart attack.

Women and men who have the symptoms described above, or in the linked articles below, should seriously think that there is the possibility that they may be having a heart attack. If that is the case, emergency treatment is necessary as soon as possible.

If you are having a heart attack, delay in getting treated is costly. Get to an emergency room, by ambulance. and have the symptoms checked out. If you go to a doctor’s office, even if he can make the diagnosis of a heart attach there, he’ll still have to send you to an ER.

The same holds true if you go to an urgent care center. Going directly to an emergency room is the best course of action. If it turns out that it isn’t a heart attack, great. If it is a heart attack, you’re where you need to be to get treated immediately or transported to a facility that has the appropriate treatment for your cardiac problem.

Here’s more information on the symptoms of a heart attack in women, and here’s some information on angina in women.


Mark Thoma, MD, is a physician who did his residency in internal medicine. Mark has a long history of social activism, and was an early technogeek, and science junkie, after evolving through his nerd phase. Favorite quote: “The most exciting phrase to hear in science... is not 'Eureka!' (I found it!) but 'That's funny.'” - Isaac Asimov

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  • KelsQualeymit

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  • docsterx

    In response to some questions, below, I referred readers to website of the American Heart Association for additional information. Just FYI, the AHA ALSO has a lot of information on strokes, too. What are they, how do they start, symptoms, etc. So for anyone looking for information on strokes, this is the place to start. They also have some information on hypertension, vascular diseases, etc. since they now include cardioVASCULAR diseased rather than just heart disease. They also discuss recognizing symptoms, discuss lipids, obesity, dieting, preventive measures and a lot of other cardiovascular topics. http://www.heart.org/HEARTORG/

  • docsterx

    Sometimes heart attack pain presents as jaw/neck pain. And the patient will often attribute it to that “bad molar” he has back there.

  • docsterx

    The study is looking at various genetic and psychological factors. I’m not sure that upper body strength is one of them. But there is evidence that fat distribution in the body can play a role in heart disease. Those people who have a lot of fat stored in the torso and pelvis are at higher risk than patients who have fat stored more uniformly with some being abdominal fat, other fat being fat in legs, buttocks, arms, etc. This research is in a fairly new area of cardiology. I’m sure that there will be more research, perhaps even including upper body strength.

  • http://musephotos.wordpress.com/ GarySFBCN

    Interesting post. I wonder if something as simple as upper body strength has anything to do with the differences in outcomes in men and women?

  • 1jetpackangel

    I’ve also heard about women getting nasty toothaches and occasionally having an impending sense of doom. Which is kinda fun for me, since I’ve got such a bad cavity that it’s become my bad weather alert, and I’m paranoid anyway.

    What makes me mad is that so few people can recognize a heart attack, male or female, mostly because of TV. TV heart attack patients always have the ‘classic’ symptoms, and they’re always men because you can’t defibrillate a woman in a bra and you can’t show bare breasts on TV.

  • docsterx

    They’ve collected a lot of raw data. And they’re going to be doing more analyses of it over the next few months or so. Some of the VIRGO information was done as poster presentations. Here’s a link that should get you access to some of those and some other information that Dr. Rachel Dreyer has produced: http://intl-circoutcomes.ahajournals.org/search?fulltext=dreyer&submit=yes&x=0&y=0

    For information on things like BMI, body fat distribution, etc. a good starting point is the American Heart Association http://www.heart.org/HEARTORG/

    Here’s one link to an article that addresses body fat distribution from the AHA.
    http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/HealthyEating/Body-Composition-Tests_UCM_305883_Article.jsp

  • bkmn

    Thanks for the info Doc! I would also like to know if the researchers are looking at factors like weight/BMI, cholesterol and lipid breakdown and if a subject was overweight, where did they carry that weight (belly or hips and what that distribution was).

    Since we know men and women tend to lay fat deposits differently is there also any correlation between obesity and coronary artery blockages in women vs. men?

  • avahome

    Thanks for the info…..something to look forward to!

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