March 28, 2021

Heart disease in women: Symptoms, diagnosis, and treatment

Heart disease may cause pain in the chest, neck, jaw, or back. However, heart disease in females can cause different symptoms. Females are more likely to experience “atypical” symptoms such as nausea, vomiting, tiredness, or no symptoms at all.

The Centers for Disease Control and Prevention (CDC) report that heart disease is the leading cause of death for females in the United States. However, only 56% are aware of the risk.

This article looks at the symptoms, diagnosis, and treatment of heart disease in females. It also looks at disparities in treatment between males and females, and how to lower the risk.

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

The symptoms of heart disease vary based on the type of heart disease a person has. Some common signs include:

  • angina, which refers to pain from blockages in the blood vessels and can cause chest pain and discomfort
  • pain in the jaw, neck, throat, upper abdomen, or back
  • shortness of breath during physical activity

However, there are key differences in how heart disease symptoms manifest between males and females. Compared with males, females are:

  • less likely to show symptoms of coronary artery disease (CAD)
  • somewhat less likely to experience chest pain
  • more likely to experience symptoms that can seem unrelated to the heart, such as nausea, vomiting, dizziness, fatigue, and stomach pain
  • more likely to experience angina that does not get better with rest, or that occurs during normal daily activities rather than during exercise

The reasons for these differences are physiological. Females typically have smaller blood vessels and feel “heart pain” differently to males.

They are also more likely to develop types of heart disease that have fewer obvious symptoms, such as microvascular disease. This means that women may get blockages in the small blood vessels or “side roads” of the heart, while CAD usually consists of macrovascular disease or blockages in the “highways” of the heart.

If a person has any signs that could indicate heart disease, they should seek medical advice right away.

To diagnose heart disease, a doctor will typically:

  • Take a medical history: Doctors may ask when the symptoms began, whether anything makes them worse or better, and about a person’s general health and lifestyle.
  • Perform blood tests: This may include a complete blood cell count, lipid profile, C-reactive protein test, sodium and potassium tests, and organ function tests.
  • Perform noninvasive tests: This could include an electrocardiogram (EKG), echocardiogram, arrhythmia monitor, cardiac MRI, or stress test.
  • Perform invasive tests: If doctors need more information, they may perform more invasive tests. This could involve cardiac catheterization, where a doctor inserts a wire in an artery to measure blood flow in small blood vessels.

A doctor may perform these tests if a person has risk factors for heart disease, even if they have few or no symptoms.

The treatment for heart disease depends on a number of factors, such as the type of disease, how advanced it is, and any other conditions a person may have. It may involve a combination of:

  • dietary and lifestyle changes
  • medications to lower cholesterol, manage blood pressure, or prevent blood clots
  • medical procedures or surgery

For some, diet and lifestyle changes are enough to reduce the risk of heart disease through management of weight, cholesterol, and blood pressure. However, people with heart disease may need medication. Common examples include:

  • beta-blockers
  • calcium channel blockers
  • ACE inhibitors
  • anticoagulants
  • nitrates
  • statins
  • aspirin

People with more severe heart disease may need surgery. This could include:

  • percutaneous coronary intervention to place stents or open blocked arteries
  • coronary artery bypass surgery to repair blocked arteries
  • valve replacement or repair
  • pacemaker or balloon catheter implantation
  • maze surgery to redirect the electrical signals in the heart and correct atrial fibrillation

Heart disease is common in females in the U.S. It is the leading cause of mortality for Black and white females, accounting for 1 in 5 deaths nationwide.

Among American Indian and Alaska Native females, heart disease causes roughly the same number of deaths as cancer. Among Latinx, Asian, and Pacific Islander females, heart disease is the second most common cause of death.

Many factors elevate the risk of heart disease in females, including:

  • smoking
  • genetics
  • air pollution
  • physical inactivity
  • lack of sleep
  • an imbalanced diet
  • mental health conditions and stress
  • working with toxic substances
  • working for long hours or shift work that affects sleep
  • autoimmune inflammatory diseases
  • obesity
  • diabetes
  • high blood pressure
  • high cholesterol
  • metabolic syndrome
  • atherosclerosis
  • HIV or AIDS
  • chronic kidney disease
  • endometriosis
  • polycystic ovary syndrome
  • anemia, especially during pregnancy
  • gestational diabetes, eclampsia, or preeclampsia during pregnancy, or having a child with low birth weight
  • hormonal contraceptive use

Some of these risk factors are more common in females, such as obesity and pregnancy-related risk factors. Some have a more pronounced impact on the risk of heart disease in females. Examples include smoking and diabetes.

Age also affects the risk in females differently to males due to the role of estrogen. After menopause, the risk of heart disease for females increases as estrogen decreases. Females who experience early menopause before the age of 40 therefore have an increased risk of heart disease.

Overall, the speed and quality of healthcare for females with heart disease is lower than that of males in the U.S.

According to the National Heart, Lung, and Blood Institute (NHLBI), females are more likely to experience delays in getting an EKG when they visit the hospital for symptoms that could indicate heart disease in comparison with males.

Doctors are also less likely to perform diagnostic tests for CAD in females, while young females are more likely to receive an incorrect diagnosis following a cardiac event. This can result in misdiagnosis and people leaving the hospital without treatment.

Females also face barriers when they do receive a diagnosis. Compared with males, they are:

  • 45% less likely to receive statins
  • 35% less likely to receive beta blockers
  • 28% more likely to visit the emergency room (ER) more than twice in a year
  • less likely to receive treatment from a heart specialist
  • less likely to receive a pacemaker or defibrillator
  • less likely to receive procedures, such as percutaneous coronary intervention or a coronary bypass

This impacts health outcomes for females, leading to increased risk of mortality.

While physiological differences between sexes explain why doctors are more likely to miss signs of heart disease in females, they do not fully explain lower standards of care once a person receives a diagnosis. Some evidence suggests that sexism within the healthcare system plays a role.

In a large 2018 study including 10,000 women with heart disease, researchers found that women were significantly more likely than men to report problems with their healthcare.

Women were 23% more likely to say that their doctor never or rarely listens to them, and 20% more likely to say their doctor never or only occasionally showed them respect. Overall, 1 in 4 felt dissatisfied with their care.

These disparities remained even after the researchers controlled for other factors, such as age, income level, insurance status, education level, and ethnicity. This suggests that gender bias has an impact on heart disease treatment in women.

The study has some limitations. In the study, 75% of women were white, 14% were African American, 10% were Hispanic, and 2% were Asian. The study did not look at how gendered racism also affects the prevalence or treatment of heart disease.

Men and women may also have different expectations of their doctors. Medication compliance could also account for these differences. However, as the study also found significant disparities in medication prescriptions and ER visits, this would not fully explain the results.

Females can reduce their risk of heart disease by both reducing risk factors where possible and by becoming well-informed about the diagnostic tests and treatment options available.

This knowledge can help people advocate for themselves and understand if they are receiving adequate care.

To reduce their risk for heart disease, people can:

  • Eat a balanced diet that is low in saturated fat, low in sodium, and high in fiber.
  • Stay active and get regular aerobic exercise.
  • Maintain a moderate weight.
  • Give up smoking and limit alcohol.
  • Monitor blood pressure.
  • Reduce stress and seek treatment for any mental health conditions.
  • Manage any other health conditions, such as diabetes, hypertension, or sleep apnea.

To prepare for appointments with doctors, the NHLBI recommend:

  • knowing and sharing personal risk factors with a doctor
  • asking for regular screening to detect heart disease early
  • learning the symptoms of heart disease in females and how they can differ from “typical” symptoms such as chest heaviness
  • seeking medical help immediately if they develop any symptoms, even atypical or vague symptoms
  • asking about specific tests and treatment options

It is also important for friends and family to learn the signs of heart disease in females, and to raise awareness of the risks.

Females should speak with a doctor promptly if they are experiencing symptoms that could indicate heart disease, even if they seem mild, or come and go. These include angina, shortness of breath, nausea or vomiting, and fatigue.

If someone is experiencing the symptoms of a heart attack, call 911 or the nearest emergency department immediately. The symptoms of a heart attack for females can include any of the following:

  • chest pain and discomfort, often in the center or on the left side of the chest, which may go away and come back again
  • weakness or lightheadedness
  • shortness of breath
  • pain in the jaw, back, or neck
  • pain in one or both arms
  • a cold sweat

Heart disease is very common among females in the U.S. However, many people underestimate the risk, including healthcare professionals.

Being informed about the symptoms is important for spotting the early signs of heart disease. Learning about the diagnostic tests and treatments available can help when it comes to accessing healthcare.