The Cardiovascular Warning Signs in Women That Look Nothing Like a Heart Attack

Heart disease is the No. 1 killer of women in the United States, yet millions of women do not know it. For decades, cardiovascular research defaulted to male subjects, medical education built its diagnostic frameworks around male symptoms, and public health campaigns left women largely out of the picture. The result is a persistent and dangerous gap: Women are more likely to have their cardiac symptoms dismissed, misdiagnosed or attributed to anxiety, and many do not find out they have heart disease until a crisis forces the issue.

We spoke with Nadim Geloo, M.D., a cardiologist and senior director of medical affairs for Abbott’s structural heart division, about why cardiovascular disease in women continues to be underrecognized, what symptoms are too often written off and what women can do right now to advocate for themselves in a health care system that has not always advocated for them.

Despite heart disease being a leading cause of death in women, there is still a gap in awareness and diagnosis. Why do you think cardiovascular disease in women continues to be underrecognized?

Nadim Geloo, M.D.: Cardiovascular disease (CVD) remains underrecognized in women because of a combination of factors, including historical clinical trial selection bias, a mismatch in symptom recognition and a profound gap in public awareness.

For decades, clinical research and medical education established a male-default baseline for what cardiovascular disease looks like, how it behaves and how it is diagnosed. Because women were historically not adequately represented in major clinical trials, the diagnostic “scripts” used by doctors and the symptom vocabulary taught to patients remained male-centric. A lack of female-focused research means both doctors and women routinely dismiss critical cardiac symptoms, like jaw pain and fatigue, as simple stress, anxiety or exhaustion, while clinicians are statistically more likely to misdiagnose these events as anxiety or musculoskeletal issues.

Ultimately, it is a failure of systemic awareness because the cultural and clinical scripts have not adequately represented the unique manifestations of heart disease in women. This is critical because heart disease remains the No. 1 killer for women; medical models need to be continuously updated to include the unique features of women suffering from heart disease. Additionally, there is a lack of public awareness campaigns to ensure people are educated about symptoms of heart disease in women so that they may seek timely health interventions.

Compared to highly visible public health campaigns like breast cancer’s pink ribbon, heart disease has a severe narrative deficit. It lacks the cultural urgency, emotional resonance and consistent public imagery needed to prompt women to proactively prioritize their cardiovascular health. When you combine this lack of public imagery with societal conditioning that misguides women to ignore their own pain to care for others, you get a systemic failure where women’s symptoms are routinely misdiagnosed, self-dismissed and tragically underestimated.

What are some of the biggest misconceptions women still have about their cardiovascular risk, especially when compared with men?

NG: The most critical misconception women still hold is that cardiovascular disease is primarily a “man’s disease,” and that breast cancer is their greatest health threat. In reality, cardiovascular disease kills more women annually than men. CVD in women continues to be understudied, underrecognized, underdiagnosed and undertreated, which is primarily the result of that misconception.

Another problem is that women may delay seeking cardiovascular care for a heart attack as they may expect the “classic” crushing chest pain typically seen in men, consequently overlooking or dismissing the “atypical” symptoms women are more likely to experience, such as shortness of breath, nausea, extreme fatigue or jaw and back pain.

Additionally, many younger women may also believe they are entirely protected by estrogen until menopause. However, many women do not realize that a history of preeclampsia, gestational diabetes or high blood pressure during pregnancy significantly increases their long-term risk for a heart attack or stroke later in life.

Are there symptoms of heart disease in women that can look different or be easier to dismiss than the “classic” warning signs many people expect?

NG: Heart disease symptoms in women can differ from those in men, which leads to women being more frequently misdiagnosed or their symptoms dismissed as anxiety-related. Although some women have no symptoms, others may experience the following:

• Unusual fatigue: A sudden, overwhelming exhaustion that makes basic tasks feel impossible, such as making the bed or walking to the car, without any obvious physical exertion. Women often dismiss this as just being “burned out” or tired.
• Shortness of breath: Feeling winded or gasping for air during light activity, or even while sitting still, often without any accompanying chest pain at all.
• Upper body discomfort: Women frequently experience a dull, aching pressure, tightness or burning in their arms, shoulders, back, neck, jaw, throat or upper abdomen. This is often mistaken for a pulled muscle or a toothache.
• Nausea and vomiting: Women can also experience symptoms that feel identical to acid reflux, indigestion or a mild case of food poisoning.

From your perspective as an interventional cardiologist, what advances in cardiovascular care are making the biggest difference for women today?

NG: The most transformative advances in women’s cardiovascular care center on our ability to diagnose and treat heart disease that disproportionately affects women.

The evolution of transcatheter therapies like Abbott’s Navitor transcatheter aortic valve implantation (TAVI) system and percutaneous mitral valve repairs like MitraClip have been a game-changer for women. Traditionally, women faced much higher complication rates during open-heart surgery due to their smaller bodies and frailty. Now, minimally invasive procedures with smaller catheter delivery systems drastically reduce vascular complications for women who inherently have smaller blood vessels.

Historically, standard angiograms failed to detect coronary microvascular dysfunction or blockages and spasms in the heart’s tiniest blood vessels, frequently resulting in women with real ischemic pain being dismissed as healthy. When a woman presents to the catheterization lab with chest pain but has “clean” major arteries, we no longer send her home undiagnosed. We now have the ability to use specialized invasive techniques to measure coronary flow reserve (CFR) and microvascular abnormalities. This allows us to directly diagnose coronary microvascular dysfunction (CMD), the dysfunction of the heart’s tiniest blood vessels that standard angiograms miss entirely.

We have shifted away from standard treadmill stress tests, which have lower accuracy rates in women. Instead, we rely on advanced cardiac MRI and quantitative positron emission tomography (PET) scanning. These technologies measure absolute blood flow to the heart muscle, allowing us to spot diffuse, widespread circulation issues without ever needing an invasive procedure.

Furthermore, advances in intravascular imaging technology, such as optical coherence tomography (OCT), now enable us to instantly identify spontaneous coronary artery dissection (SCAD), a tear in the artery wall that is an important cause of heart attacks in younger women, preventing the catastrophic mistake of treating these fragile tears with standard stenting protocols. Knowing exactly what we are looking at allows us to manage these women safely with medical therapy instead.

What are the most important steps women can take to better advocate for themselves if they feel their symptoms or concerns are being overlooked?

NG: To help women navigate a health care system that still exhibits systemic gender bias, I recommend taking these specific, highly strategic steps to advocate for themselves if they feel their cardiovascular concerns are being dismissed:

• Instead of simply describing your symptoms as “fatigue” or “indigestion,” which are easily brushed off as lifestyle issues, explicitly state your concern to your doctor. For example, use the phrase, “I am concerned that these symptoms could be cardiac in origin. What tests can we run today to rule out a heart issue?”
• Bring a written, dated log of your symptoms, recording what you felt, when it happened, and how it limited your daily life. Saying, “I experienced sudden shortness of breath and jaw tightness on Tuesday at 2 p.m. while folding laundry, and had to sit down for 20 minutes,” provides clinical data that are much harder for a physician to dismiss as general stress or anxiety.
• If your physician declines to order diagnostic testing, such as an EKG, echocardiogram or a referral to a cardiologist that you feel is necessary, consider a second opinion or seek out direct consultation with a cardiologist.
• Additionally, whenever possible, bring a trusted partner, family member or friend to your appointment. Permit them beforehand to speak up, as having a second person in the room not only provides emotional support but changes the dynamic of the room, ensuring that your symptoms are validated and that you have a witness to the care you are or aren’t receiving.
• If you feel you are hitting a wall with your primary care doctor or a general cardiologist, seek a second opinion from a cardiologist who specializes in women’s cardiovascular health. These specialists are specifically trained to look for microvascular dysfunction, SCAD and atypical presentations, and they are far more likely to take your symptoms seriously from Day 1.