Women are vulnerable to heart attacks, but the symptoms and risk factors can be different from what many people expect. Cardiologists cited by the American Heart Association and the Mayo Clinic say the “Hollywood” version of a heart attack—sudden collapse after one obvious warning—doesn’t reliably match what women experience. As a result, some women may delay care even after warning signs appear.
The story highlights how widespread cardiovascular disease is for women in the United States. Dr. Sharonne Hayes, a cardiologist at the Mayo Clinic in Rochester, Minnesota, said cardiovascular disease is “the No. 1 killer of women,” adding that “It will affect you or someone you know.” She emphasized that knowing what to do when symptoms suggest a heart attack and taking action quickly is “really important.” The guidance comes as more than 60 million women in the U.S. live with cardiovascular disease, including heart disease and stroke, along with heart failure and atrial fibrillation.
Doctors also point to prevention efforts that start before symptoms happen. The American Heart Association’s “Life’s Essential 8” focuses on actions that include eating better, quitting tobacco, getting healthy sleep and being more active. It also includes controlling cholesterol and managing weight, blood sugar and blood pressure, with clinicians recommending regular checkups to discuss preventive steps and any relevant family history of heart problems.
Cardiovascular risk can rise through conditions and life events that more often affect women. The guidance says women are more likely to have autoimmune conditions such as lupus or rheumatoid arthritis, which can drive inflammation that increases heart disease risk. It also notes that women are more likely to experience depression, which can correlate with inflammation and unhealthy behaviors. Other risk factors mentioned include a history of high blood pressure or diabetes while pregnant, miscarriages or stillbirth, and hot flashes and night sweats during menopause, which have been linked to higher blood pressure and other cardiovascular risk factors.
Health experts say people should treat symptoms as possible heart-attack signals rather than waiting for a single classic pattern. When people imagine heart attacks, Hayes said, “it’s not going to probably be one of those Hollywood heart attacks.” Chest pain or discomfort can occur, but it is not the only warning sign, and Rosen said what’s different is that women are more likely than men to have other symptoms as well. Those symptoms can include back pain, shortness of breath, cold sweats, tiredness, nausea, lightheadedness, an anxious feeling, jaw pain and finger tingling.
The guidance also addresses how symptoms may start and change. Hayes said she often hears women describe a symptom pattern that “waxed and waned” over time—“I got the symptom and it waxed and waned a little bit over time, but I knew something wasn’t right.” Experts are not certain why symptom patterns differ between men and women, but research cited alongside the guidance suggests physiological differences may play a role.
If symptoms suggest a heart attack, clinicians urge emergency action. Rosen said, “If you think that there’s even a chance that you’re having a heart attack, that’s when you call 911,” adding that it’s better to “err on the side of over-concern than err on the side of minimizing something that could be quite serious.” Doctors also recommend taking an ambulance to the hospital because emergency teams and equipment are more prepared than urgent care or a doctor’s office. Rosen warned that “If you wait too long,” the damage “can be more significant.”
The advice echoes the experience of Lori Sepich, a 64-year-old from Memphis, Tennessee, who described two heart attacks 13 years apart. According to Sepich, during her first heart attack she waited too long, saying she had been in denial about her heart problems after being diagnosed with severe, hereditary high blood pressure at 17. On Easter Sunday 2005, she woke up with extreme chest pressure, nausea and pain radiating down her arms, but she said she chose to ignore the signs because “I was absolutely in shock,” and “I was scared.” She attended Mass and a family lunch before going to work the next day, and eventually reached the emergency room at her doctor’s urging, where she received six stents placed and spent a week in the hospital.
Sepich said she acted more quickly when she had her second heart attack. Her cardiologist found a nearly complete blockage in the heart’s biggest artery, and she received another stent. She now keeps her blood pressure under control, exercises almost every day, and has not smoked for more than two decades. Sepich said she wants other women to be honest with themselves about heart disease, including what she described as justifications made from denial. She told the public, “I could justify my actions from denial. I could just be like, ‘Oh, it’s not gonna hurt you,’” then added, “Well, it does hurt you. It can kill you.”