Key Differences in Heart Attack Symptoms for Men and Women, According to an Interventional Cardiologist

Did you know that a heart attack, or myocardial infarction, may present differently for men and women? The symptoms of a heart attack can differ across genders. It is thus vital for everyone, especially those with risk factors for cardiovascular diseases, to understand these differences. This is because timely detection of a heart attack is crucial for emergency medical care to maximise the chance of survival.

Common Symptoms of a Heart Attack

Heart attack symptoms largely overlap in similarity between men and women, but can vary in intensity and duration. The initial symptoms that may indicate the onset of a heart attack may include heaviness, tightness, pain, or discomfort in the following areas of the body:

• Chest
• Shoulder
• Jaw
• Arm
• Neck
• Mid-back

These sensations may also be accompanied by cold sweats, difficulty breathing, nausea, light-headedness or tiredness.

If you experience one or more of these symptoms, you should alert someone and immediately call 995 for an ambulance. It is important to seek medical help immediately. A heart attack, if left untreated, can lead to serious complications or even death.

There may be instances where none of the above symptoms are present and you experience only a mild vague discomfort, similar to acid reflux or indigestion. This sensation may be a symptom of a silent heart attack and may occur more frequently in people with diabetes.

However, there may be certain gender-specific symptoms of heart attack that are more commonly reported or pronounced.

Symptoms of a Heart Attack That Are More Common in Women Than Men

 

Women typically experience more atypical heart attack symptoms compared to men, such as brief or sharp pains felt in the arms, neck, jaw or back. Women may also tend to report more generalised symptoms rather than chest pain compared to men, and these symptoms include fatigue, nausea, and light-headedness. 

However, there are recent studies which reported that women and men are likely to suffer from chest pains of similar intensity, and not milder or stronger in either gender.

A Heart Attack May Be Mistaken for These Medical Conditions

 

It is important to note that symptoms of a heart attack may be mistaken for other medical conditions: 

• Gastrointestinal Disorders: Gastritis or gastro-oesophageal reflux disease may present with symptoms such as nausea, vomiting, abdominal pain, and indigestion.
• Musculoskeletal Problems: Musculoskeletal issues, such as muscle strain or inflammation may present with chest pains.
• Respiratory Problems: Respiratory conditions like bronchitis, asthma or chronic obstructive pulmonary disease may present with symptoms of shortness of breath or difficulty breathing.
• Generalised Anxiety Disorder (GAD): GAD has many of the symptoms similar to a heart attack, such as fatigue, abdominal discomfort, tightening in the chest, sweating, light-headedness, and shortness of breath.

Call an Ambulance Immediately If a Heart Attack is Suspected

 

If you suffer from these symptoms and are not sure if it is due to a heart attack or these other conditions, the safest option is to seek immediate medical attention.

If the symptoms are persistent and ongoing, call for an ambulance immediately. The ambulances are prepared to respond rapidly, and they will take you to the nearest hospital. For someone having a heart attack, every minute is important. Remember, the faster you get to a hospital, the sooner you can receive treatment. 

A heart attack, if left untreated, can lead to serious complications or even death.

Underlying Biological Differences Which Affect Heart Attack Risks in Men vs Women

There are many overlapping heart disease risk factors which affect both men and women, such as obesity, old age, frequent smoking, a family history of heart attacks, chronic high blood pressure, diabetes, and a sedentary lifestyle. 

Nonetheless, some heart attack risk factors are gender-specific because they stem from underlying biological differences between men and women:

• Gender differences in the size of the heart and blood vessels: Women have smaller hearts and narrower blood vessels than men, which may lead to a different rate of heart disease progression.

• Gender differences in cholesterol buildup areas: Plaque buildup tends to occur in the heart’s smallest blood vessels for women, whereas men tend to develop plaque in larger coronary arteries. Therefore, females may experience more heart attacks with atypical symptoms than men.
• Gender differences in cholesterol level: Generally, men tend to have higher total cholesterol levels than women, which may contribute to a higher risk of heart attack.

Additionally, women specifically have a higher risk of a heart attack when they have a history of preeclampsia. Preeclampsia is a possible complication of pregnancy that causes high blood pressure, kidney damage and other forms of organ damage. It increases the lifetime risk of heart disease. 

Overall, men have a higher risk of suffering from heart attacks relative to women. Although gender is an unmodifiable risk factor, risk factor control is still important for both men and women. There are concrete lifestyle habits that everyone can adopt to alleviate certain modifiable risk factors for heart attacks.

How to Lower the Risk of Developing Heart Diseases

For any individual looking to lower the risk of developing heart disease, regardless of gender, a healthy lifestyle is recommended. This includes not smoking, exercising regularly, managing stress levels and maintaining low blood cholesterol and pressure. 

If you have chronic high blood cholesterol, reducing your consumption of fatty foods can help alleviate the issue. Your cardiologist may also prescribe you drugs to help. Routine cardiac screening tests to assess if any diet changes have affected your blood cholesterol levels are also recommended. 

Chronic high blood pressure can be fixed by reducing sodium intake and exercising regularly, but many individuals may find it beneficial to get prescription medicine to lower blood pressure. 

Diagnosis and Treatment of Heart Attacks for Men and Women

Most heart attack diagnoses happen in an emergency setting. Diagnosis of a heart attack includes assessment of symptoms and checking vital parameters such as blood pressure and pulse rate. Specialised tests such as cardiac markers (blood test), and ECG may be confirmatory of a heart attack. In terms of the investigations for suspected heart attacks, men and women should expect the same level of quality care.

Emergency treatment for a heart attack may include giving additional oxygen, antiplatelet medications such as Aspirin or Plavix, and to undergo an emergency coronary angioplasty (a minimally invasive procedure following a coronary angiogram where small devices are used to unblock the coronary arteries). 

Once you are stabilised, further tests, such as a Transthoracic Echocardiogram , may be done to assess your heart function. You will be prescribed medications and your cardiovascular risk factors will be optimally controlled.

Following a heart attack, your doctor will give you advice on weight, diet, physical activity, medications and other lifestyle changes. It is important to follow these recommendations to aid in your recovery and to avoid any future attacks.

You may also be enrolled in a cardiac rehabilitation programme, designed to guide you in improving your cardiovascular health through education and exercise counselling and training.

Summary

Symptoms of Heart Attacks

	Males	Females
Pain and discomfort in the chest*, shoulder, jaw, arm, neck, and mid-back	Present	Present
Fatigue	Less common	More common
Nausea	Less common	More common
Light-headedness	Less common	More common

*Chest pain experienced by women may also be an indicator of breast cancer, not heart attacks.

Risk Factors for Heart Attacks

	Males	Females
Narrower blood vessels	Less likely	More likely
High cholesterol	More likely	Less likely
Preeclampsia (a possible complication of pregnancy)	Not applicable	Applicable

Men and women share very similar symptoms, risk factors, and treatment when it comes to heart attacks. However, some women may mistake the symptoms of heart attacks for other diseases. Importantly, heart attack symptoms, such as sudden chest pain, tiredness, and numbness, should always be taken seriously regardless of gender and immediate medical attention should be given.

Although men are more likely to experience heart attacks in general,  risk factor control is important for both genders.

Visit Capital Heart Centre

Capital Heart Centre offers detailed cardiac screening services in Singapore to help you determine your risk of heart attacks.

For an accurate diagnosis of your cardiovascular problems, schedule an appointment with Dr Joshua Loh, Senior Consultant Interventional Cardiologist at Capital Heart Centre. He has more than 15 years of experience in the field of cardiology, including complex coronary and interventional procedures.

Reference

1. Sex Differences in the Presentation and Perception of Symptoms Among Young Patients With Myocardial Infarction: Evidence from the VIRGO Study. Published February 20, 2018
   https://pubmed.ncbi.nlm.nih.gov/29459463/
2. HERMES: Say Goodbye to Typical and Atypical Angina Terminology? American College of Cardiology. Published September 2, 2019.
   https://www.acc.org/latest-in-cardiology/articles/2019/08/28/13/42/mon-5am-hermes-esc-2019
3. Brigham and Women’s Hospital. Heart Disease: 7 Differences Between Men and Women. Brigham and Women’s Hospital. https://give.brighamandwomens.org/7-differences-between-men-and-women/
4. Heart Attack. Mayo Clinic.
   https://www.mayoclinic.org/diseases-conditions/heart-attack/diagnosis-treatment/drc-20373112

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