November 2, 2026
A heart attack doesn't always present in a dramatic way as sometimes shown in TV and film, especially for women. Instead, the warning signs may be subtle, such as unusual fatigue, indigestion, shortness of breath or simply the sense that something isn't right. Ironically, these symptoms often blend with other conditions, which can make the leading cause of death for women in the United States dangerously easy to overlook.
The difference in how symptoms present matters because symptoms that do not seem obviously heart-related can be easily dismissed as stress, anxiety, aging, perimenopause or menopause. And with busy lives, it’s often easier to delay care until “things settle down.”
Naddi Marah, MD, a board-certified cardiologist and interventional and structural cardiologist at Memorial Hermann Medical Group in Cypress, says recognizing those differences and understanding your individual risk can help women take a more proactive approach to their cardiovascular health.
“Chest pain is the most common heart attack symptom in both men and women, but many women don't experience that dramatic chest-clutching symptom you see in movies and TV shows. Sometimes, the warning signs in women are much more subtle,” Dr. Marah says.
Why Heart Disease Can Look Different in Women
For years, the symptoms most associated with heart disease were largely based on how the disease presented in men. Dr. Marah says women have long been underrepresented in cardiovascular research, which only furthers the impression that heart attacks always involve significant chest pain or pressure.
As Dr. Marah noted, women can experience those classic symptoms, too. But it’s also common to instead experience shortness of breath, profound fatigue, faintness or a sensation that can feel like indigestion. Dr. Marah says these less obvious symptoms may be particularly important to recognize in women over 60 and those with diabetes.
Furthermore, there are also physiological differences between men and women that can influence how heart disease develops and presents. Women are more likely than men to experience problems involving the heart's smaller blood vessels, including plaque buildup and spasms. This type of microvascular disease can cause more subtle symptoms rather than the heavy chest discomfort commonly associated with a blockage in a larger coronary artery.
Symptoms may also emerge under different circumstances, according to Dr. Marah. “Women may be more likely than men to experience symptoms while resting, sleeping or during emotional stress such as crying or yelling, while men more often experience symptoms with heavy physical activity,” he says.
Menopause Can Change Your Heart Disease Risk
A woman's cardiovascular risk also changes throughout her life, especially after menopause. This happens because higher estrogen levels before menopause provide a protective effect on blood vessels.
“After menopause, declining estrogen levels can affect how blood vessels respond to stress, inflammation, high blood pressure, diabetes and nicotine,” Dr. Marah explains. “These changes can contribute to plaque buildup in the arteries, increasing a woman’s risk of coronary artery disease and heart attacks.”
This does not mean women should wait until menopause to start thinking about heart health, however. In fact, some of the factors that influence cardiovascular risk can appear much earlier, including during the reproductive years.
Know the Heart Disease Risk Factors That Are Unique to Women
Many of the major risk factors for heart disease affect both women and men. These include high blood pressure, high cholesterol, diabetes, smoking, excess weight, inactivity and family history. But a woman's medical history can provide additional clues about her future cardiovascular risk.
Dr. Marah says women should make sure their health care providers know if they have experienced certain conditions, including the following:
- Preeclampsia
- Gestational diabetes
- Gestational hypertension
- Polyendocrine metabolic ovarian syndrome or PMOS, (formerly called polycystic ovarian syndrome or PCOS)
- Early menopause
- Certain autoimmune conditions, including lupus and rheumatoid arthritis
- Thyroid conditions
A history of breast cancer treatment can also be a risk factor in heart attacks. Dr. Marah notes that certain treatments for breast cancer may affect heart function and radiation to the chest may contribute to accelerated plaque buildup in the coronary arteries.
Pregnancy history is particularly important because a condition that resolves after delivery may still provide information about cardiovascular risk years later. “A history of preeclampsia, a pregnancy complication characterized by new-onset high blood pressure together with protein in the urine, is associated with roughly double the risk of heart disease and stroke and about four times the risk of heart failure later in life,” Dr. Marah says.
While these conditions do not mean a woman will absolutely develop heart disease, they are pieces of health history that can help her physicians better understand her overall risk.
Know the Signs of a Heart Attack in Women
Chest pain or discomfort remains an important heart attack symptom in women, but it should not be the only symptom women know. Dr. Marah discussed the following list as potential warning signs:
- Chest pressure, squeezing, heaviness, burning or discomfort
- Sudden shortness of breath
- Profound or unusual fatigue
- Feeling faint or passing out
- Indigestion-like symptoms
- Chest discomfort accompanied by a rapid or irregular heartbeat
- A general feeling that something is wrong or that you don't feel like yourself
Symptoms that appear while resting, last several minutes or go away and return should also be taken seriously. The important point is that if you suspect you may be having a heart attack, Dr. Marah says you should not wait at home to see whether the symptoms improve.
“You should never try to manage heart attack symptoms at home. There's nothing wrong about calling 911 immediately or going to an emergency center for evaluation, especially if your symptoms are new,” he says. “I would rather evaluate 10 women whose symptoms turn out not to be a heart attack than miss that one person who stays home and suffers irreversible heart damage.”
Even when testing is negative for a heart attack, a visit may uncover another health issue that deserves attention. High blood pressure, high cholesterol or diabetes, for example, can increase future cardiovascular risk even when they are not causing an immediate emergency.
“It's never wrong to go to the hospital to get your symptoms evaluated. You will never be made to feel guilty for doing so. We may not diagnose a heart attack, but we might still find signs of heart disease,” Dr. Marah explains.
Heart Disease Prevention Starts with Knowing Your Risk
You do not need to wait for symptoms to begin paying attention to your cardiovascular health. In fact, Dr. Marah says prevention is much easier than managing heart disease after a cardiovascular event has already occurred.
A good place to start is knowing your numbers and understanding the factors that put you at greater risk. That includes keeping track of blood pressure, cholesterol and blood sugar as well as maintaining a healthy weight. Regular physical activity, a heart-healthy diet, avoiding tobacco, getting adequate sleep and managing stress can also contribute to long-term cardiovascular health.
Dr. Marah recommends moderate-intensity exercise for about 30 minutes at least three times a week. “That's exercise where you are huffing and puffing,” he says. “If you can sing the words to your favorite song, you're not exercising. If you can talk to your husband, your kids or your friend on the phone, you're not exercising.”
For diet, he recommends emphasizing vegetables, fruits, whole grains, beans, nuts, fish and lean proteins while limiting highly processed foods, excess sodium, added sugars and saturated fats. He also recommends seven to nine hours of sleep each night.
Family history deserves attention, too. Knowing that a parent or grandparent had a heart attack is useful, but knowing when it happened and what cardiovascular risk factors they had can provide even more information. Dr. Marah says it’s worthwhile to know the heart history of your family, especially if a relative has ever had a heart attack and at what age. The next time you’re spending time with extended family during the holidays, take some time to investigate your family’s health history.
The Importance of a Coronary Artery Calcium Score for Those at Risk
Dr. Marah says he first considers a patient's symptoms, family history, blood pressure and other risk factors when determining a patient’s risk level. However, he recommends additional testing for some patients so they can better understand their true cardiovascular risk.
One option for this additional testing is a coronary artery calcium (CAC) score. This quick CT scan looks for calcified plaque in the arteries of the heart. The results can provide additional information that may help your physician determine whether further testing or preventive treatment is appropriate.
A CAC score is not something every woman automatically needs, but it can be a vital tool in fighting heart disease. Talk with your health care provider about your personal and family history and whether additional cardiovascular testing may be appropriate for you.
Listen to Your Body and Start with Sustainable Changes
Importantly, women should pay attention when their body feels different and advocate for themselves when they seek medical care. Heart disease in women does not always announce itself with the symptoms you’d expect. “Listen to your body, and know and understand your risk factors,” Dr. Marah says.
Protecting your heart does not require transforming every aspect of your life at once. Instead, start by understanding your risk and knowing your family history. From there, be sure to maintain routine health care and make sustainable diet and lifestyle changes to support your cardiovascular health over time.
“Remember, prevention is not about achieving perfection overnight,” Dr. Marah says. “We all have busy lives and busy schedules, but we all have the ability to make sustainable changes that can substantially reduce cardiovascular risk over our lifetime.”
