Symptoms to watch for in women with MIs

There are some significant differences in women vs. men when it comes to a heart attack.

Women have a different symptom complex than men, says Barbara Riegel, DNSc, RN, CS, FAAN, professor at the school of nursing at San Diego State University.

"The substernal crushing chest pain picture that we were all taught seems to be a male phenomenon," she explains. "Recognize that women may not present with the classic pattern."

Here are several differences to be aware of:

Women tend to have heart attacks when they are older.

Women have heart attacks, on average, when they are older. "Some 85% of all heart attack deaths in women occur over the age of 65," notes Mary M. Hand, MSPH, RN, coordinator of the National Heart Attack Alert Program in Bethesda, MD.

Before menopause, women seem to be better protected from heart disease by their hormones, explains Hand. "Since women tend to be older [when they have a heart attack], diagnosis may be more difficult because of other health problems such as coexisting hypertension, or congestive heart failure," she says.

Chest pain may be less

Women might have different presenting symptoms.

Compared to men, women might report less strong chest pain, Hand says.

"Also, a woman may first feel shortness of breath; indigestion; and jaw, neck, arm, back, or shoulder pain," she says. "She may break out into a cold sweat or feel lightheaded."

Women often have pain in different places.

Pain may be present in the back or the neck and might be described as discomfort, says Riegel.

"They may have associated symptoms like shortness of breath or nausea instead of true pain," she says.

Look for distress over symptoms rather than location, says Riegel. "That is, if someone is extremely upset by their symptoms, she is telling you something," she emphasizes. "Be suspicious that it could be serious, rather than just assuming it’s not an MI because it’s not in the right spot."

Women should call within 15 minutes

Women might delay longer.

Studies have shown that women are more likely to delay seeking treatment, says Hand.1 "This may be because they are more likely to be living alone and have no one immediately present to tell about their symptoms," she suggests. "They may worry about who will take care of their family. Or they may have the usual fear of loss of control or embarrassment over calling an ambulance."

Delay costs lives and damages heart muscle, which affects the quality of life after a heart attack, stresses Hand. Instruct women to call 911 within 15 minutes of experiencing symptoms so they can get to a hospital right away, she says.


1. National Heart Attack Alert Program. The physician’s role in minimizing prehospital delay in patients at high risk for acute myocardial infarction: Recommendations from the National Heart Attack Alert Program. Ann Intern Med 1997; 126:645-651.


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