The Dangerous Myth About Women’s Heart Attack Symptoms
Many women who arrive at emergency departments with heart attack symptoms are still misdiagnosed or sent home, despite reporting serious warning signs. Cardiologists say one subtle but dangerous reason is the continued use of the word “atypical” to describe how women experience heart attacks.
Barbara Collura, an ambassador for the Family Heart Foundation in the United States, experienced this problem firsthand. She sought medical help after developing shortness of breath, sweating and pain in her back that radiated down her left arm. Because her initial tests appeared normal, she was discharged. A later cardiology appointment also ended with her symptoms being attributed to anxiety.
That same night, Collura suffered a heart attack. Only during her third medical visit did she receive the correct diagnosis, by which time one of her arteries was found to be 99 percent blocked. Her story reflects the experiences of many women whose symptoms do not match the traditional male-centered image of a heart attack.
How Gender Bias Influences Diagnosis
Cardiovascular disease remains the leading cause of death among women in the United States, causing a similar number of deaths each year as it does among men. Despite this, research shows that women under the age of 55 are about seven times more likely than men to be discharged from emergency departments without appropriate cardiac testing when they report possible heart attack symptoms.
Even in countries with advanced healthcare systems, such as Australia, researchers estimate that up to 20 percent of heart attack deaths among women could be prevented if gaps in diagnosis and treatment were eliminated. Although awareness campaigns have improved public understanding of women’s heart health, experts argue that medicine still frequently treats the male body as the default model.
This bias is also reflected in treatment decisions. Studies have found that women presenting with heart attack symptoms are less likely than men to receive aspirin, undergo resuscitation after cardiac arrest or be transported by ambulance under emergency conditions. According to researchers, these patterns suggest that women’s symptoms are often underestimated during critical moments.
The Problem With ‘Atypical’ Symptoms
For many years, medical education has described women’s heart attack symptoms as “atypical” because they often involve more than severe chest pain. However, recent observational studies and prospective clinical research have shown that more than 90 percent of both women and men experience some form of chest pain during a heart attack.
Women, however, are more likely to experience additional symptoms, including nausea, shortness of breath, unusual fatigue, jaw pain and pain between the shoulder blades. Cardiologists warn that these overlapping symptoms can complicate diagnosis, particularly when clinicians assume that “atypical” symptoms are less likely to indicate heart disease.
Stephen Nicholls, director of Australia’s Victorian Heart Hospital, is among the experts calling for the term to be abandoned. He argues that labeling symptoms experienced by half the population as atypical reinforces the misconception that heart disease is primarily a male condition and may encourage doctors to dismiss women’s symptoms as anxiety or non-cardiac discomfort.
Yentl Syndrome and Outdated Evidence
The disparity in cardiac care is often referred to as Yentl syndrome, a term introduced in 1991 by cardiologist Bernadine Healy. Named after the film in which a woman disguises herself as a man to gain access to education, the concept describes how women frequently receive equal medical treatment only when their symptoms resemble those typically seen in men.
More than three decades later, cardiology continues to grapple with this issue. Many foundational heart disease guidelines, including recommendations involving aspirin and other therapies, were originally based on clinical trials that enrolled predominantly male participants. As a result, women’s specific risk profiles have often been underrepresented.
Risk factors that are unique to women or more common among them, including menopause-related changes, polycystic ovary syndrome, preeclampsia and gestational diabetes, may therefore receive insufficient attention during routine cardiovascular risk assessments. Experts say this can lead to an underestimation of women’s true risk.
What Heart Attacks Often Feel Like for Women
Heart attacks are frequently portrayed as sudden events marked by crushing chest pain. However, cardiologist Michelle O’Donoghue of Brigham and Women’s Hospital and Harvard Medical School notes that this stereotype can cause both patients and clinicians to overlook less obvious warning signs.
According to O’Donoghue, women often describe heart attack symptoms as a dull pressure, heaviness or discomfort in the chest rather than sharp pain. Symptoms may come and go rather than appearing suddenly and intensely. Women are also more likely than men to experience heart attacks while resting or sleeping, making symptoms easier to dismiss as stress, indigestion or fatigue.
Research further shows that women experiencing heart attacks are more likely to report pain between the shoulder blades, shortness of breath, nausea and vomiting. Because these symptoms have long been labeled “atypical,” they are more likely to be misinterpreted as unrelated to the heart, contributing to dangerous delays in treatment.
Slow Progress Toward Better Guidelines
Recent cardiovascular guidelines in North America and Europe place greater emphasis on a wider range of symptoms. Clinicians are increasingly encouraged to view unexplained shortness of breath, jaw pain, arm discomfort, severe fatigue and other nontraditional symptoms as potential signs of heart disease.
The goal is to reduce the number of missed diagnoses among women. However, experts acknowledge that changing long-standing clinical habits takes time. Many healthcare professionals were trained using older models that focused heavily on classic male-pattern chest pain and paid less attention to other presentations.
Nicholls believes awareness is improving but argues that more work is needed to incorporate sex-specific evidence into risk calculators, clinical protocols and quality measures. Without broader structural changes, he warns that outdated concepts surrounding “atypical” symptoms will continue to place women at unnecessary risk.
What Patients Should Know
While healthcare systems work toward improvement, cardiologists emphasize the importance of individual awareness. O’Donoghue advises anyone experiencing new or unexplained chest discomfort, shortness of breath, nausea, unusual fatigue or pain in the jaw, back or arm to seek immediate medical attention, particularly if symptoms persist or recur over several minutes.
She stresses that it is safer to seek urgent evaluation than to wait, since early treatment can reduce damage to the heart muscle and improve survival. Individuals who suspect they may be having a heart attack should call emergency services rather than drive themselves to the hospital, allowing treatment to begin as quickly as possible.
Collura now shares her experience through the Family Heart Foundation in the hope that fewer women will be told their symptoms are simply anxiety or “atypical.” Her story reinforces a message increasingly echoed by cardiologists around the world: women’s heart attack symptoms are common, serious and potentially life-threatening, and the language used to describe them can influence whether patients receive timely care.
