Heart disease is the number one cause of death for American women, killing almost 1 in every 4 women. But a new study finds patients and even medical providers are missing important heart attack signs in women.

Many recognize that crushing sensation in your chest as a main symptom for a heart attack, but a recent study led by the Yale School of Public Health found that other lesser-known heart attack symptoms — especially in women — aren’t being recognized by doctors and patients.

About 90 percent of men and women experience some chest discomfort during an acute myocardial infarction (AMI), or heart attack. However, not all AMI events are associated with chest pain.

And these non-chest pain symptoms may be misdiagnosed or ignored if they’re assumed to be something less serious, like acid reflux.

Researchers in the study published this month in the Circulation medical journal looked at 2,009 women and 976 men between the age of 18 and 55 admitted to over 100 hospitals across the United States for AMI.

The researchers conducted interviews to find out which symptoms women had before their hospital visit and what they believed the symptoms were. Researchers also checked to see if participants had prior visits with a healthcare provider.

Almost 62 percent of women presented with more than three non-chest pain symptoms, compared to 54.8 percent of men. Women were more likely than men to report symptoms such as stomach pain, shortness of breath, palpitations in their chest, nausea, and dizziness.

Additionally, 53 percent of women said “their healthcare provider did not think the symptoms were heart-related,” compared to only 36.7 percent of men.

“I’m really quite concerned about it,” Dr. Nieca Goldberg, cardiologist and medical director of the Joan H. Tisch Center for Women’s Health at NYU Langone told Healthline. “Sometimes the doctor is not putting it together… [physicians] need to change the course and trust and listen to patients to get the patient’s and their family’s whole story.”

If these symptoms are misinterpreted or ignored, young women have a “higher risk of mortality” or having complications from a heart attack.

Missing heart attack signs

Both men and women often didn’t realize they were exhibiting potential signs of a heart attack.

Researchers found nearly 50 percent of both men and women thought their symptoms were related to noncardiac conditions. Most commonly, study participants thought their symptoms were related to indigestion or acid reflux, and 20.9 percent of women related their symptoms to stress and anxiety.

Almost two-thirds of men and women reported that they only decided to seek medical care because they had persistent symptoms. Over half reported that their pain was too bad to ignore. A greater percentage of women than men did state they sought medical care for their symptoms prior to being admitted.

Goldberg said that physicians shouldn’t be overlooking these other lesser-known heart attack signs.

“The majority of men and women are reporting symptoms that are classic to a heart attack,” Goldberg said. “However, this study also supports what we already know — that women are more likely to report other symptoms.”

Despite both men and women having risk factors for cardiac disease, women are more likely to have a history of diabetes, obesity, stroke or ministroke, congestive heart failure, chronic lung disease, and chronic kidney disease.

“We have to work to make sure our message about cardiac symptoms gets out to all women so they are better equipped when they have their symptoms,” Goldberg said. “Most importantly, women are having the symptoms weeks before the heart attack starts, and [healthcare workers] need to find and urge them to get medical care to prevent them from going to the emergency department when it is too late.”

Although the risk factors and the classic presentation of chest pain for a heart attack hasn’t changed, additional awareness needs to be made for further prevention. Just 54 percent of women realize that cardiac disease is the number one killer for them in the United States, according to the Centers for Disease Control and Prevention.

Goldberg urges patients “to discuss their cardiac symptoms and potential risk factors with [their] primary doctor, cardiologist, and even their gynecologist.”

“They need to learn the symptoms of heart attack, get a checkup, and discuss their heart disease risk before having the symptoms themselves,” she said. “The idea is to prevent the first heart attack — not just recognize it when it is happening.”

Heart attack signs women (and men) can miss

  • unusual fatigue for several days, or sudden in onset
  • sleep disturbances
  • shortness of breath
  • lightheadedness, nausea, or a cold sweat
  • indigestion or gas-like pain
  • pain in one or both arms, pain that goes to the neck, jaw, or back
  • pressure in the center of your chest that may spread to your arm