It’s Valentine’s Day, the whole world is covered in red hearts, and February is also American Heart Month, which is a less cute reason to talk about hearts. Here’s the number that changed how I think about heart attack symptoms in women: in a large Yale study of younger heart attack patients, 53% of the women said a health care provider had told them their symptoms weren’t heart related before they were diagnosed. For men, it was 37%.
I’d always assumed the danger for women was that our symptoms are mysterious and easy to miss. That’s part of it. But the research points to something more uncomfortable. Many women feel classic symptoms, notice them, go to someone for help, and still get sent home. So knowing the warning signs is only half of what you need. The other half is knowing what to say, and being willing to say it twice.
I’m not a doctor, and nothing here replaces one. If you have symptoms right now, stop reading and call 911.
Heart disease is the top killer of women, and fewer of us know it
According to the CDC, heart disease is the leading cause of death for women in the United States, responsible for about 1 in every 5 female deaths. That’s more than any single type of cancer.
Awareness has gone the wrong way. The American Heart Association surveys women about this every few years, and in its 2019 survey, published in Circulation in 2020, only 44% of women knew heart disease was their leading cause of death. In 2009, 65% had known. The steepest drop was among women aged 25 to 34, the group most likely to believe this is something that happens to their grandmothers.
Picture a room of 100 women. In 2009, 65 of them would have known the answer. A decade later, 44 did. That’s 21 fewer women in every hundred who’d think “heart” first if something felt wrong in their chest.
Most heart attack symptoms in women still include chest pain
This is the gap in a lot of what you’ll read this month. Plenty of articles list “women’s symptoms” as if they’re completely different from men’s: nausea, fatigue, jaw pain. Those are real. But the biggest study of younger heart attack patients found that chest pain was still the main symptom for most women.
That study, called VIRGO, was led by researchers at Yale and published in the journal Circulation in 2018. It followed 2,009 women and 976 men aged 55 or younger who’d been hospitalized for a heart attack at more than 100 hospitals. Between 85% and 90% of patients of both sexes had chest pain, pressure, tightness, or discomfort. Where women differed was in the extra symptoms: they were more likely than men to also report indigestion, shortness of breath, palpitations, or pain in the jaw, neck, or arm, according to the Yale School of Medicine’s summary.
The CDC’s list for women matches this. It includes chest discomfort that can feel dull, heavy, or achy, along with pain in the neck, jaw, throat, upper abdomen, or back, plus nausea, vomiting, unusual tiredness, and shortness of breath. So the pattern to remember is chest symptoms plus extras, not “women don’t get chest pain.”
The real danger is being talked out of your own symptoms
Now go back to that 53% figure, because it’s the part I can’t stop thinking about. Out of 2,009 women, 53% works out to roughly 1,065 women who were told by a provider that what they felt wasn’t their heart. Among the 976 men, 37% is about 361 men. Proportionally, women were dismissed almost one and a half times as often.
I don’t read this as a story about careless doctors. A younger woman with chest discomfort plus indigestion or shortness of breath can look like a lot of things, from reflux to a pulled muscle to a panic attack, and a busy clinician working through that list may land on the common answer first. That’s exactly why you can’t count on someone else to make the connection for you. You’re the only person in the room who knows how unusual this feeling is for your body, and that information is worth saying out loud.
Decide now what you’ll say if something feels wrong
The most useful thing I did this month took five minutes. I wrote down, in my phone’s notes, the exact words I’d use in an urgent care or emergency room if I ever had chest symptoms: “I’m having chest pressure and I’m worried it could be my heart. Can we rule out a heart attack?” Then the follow up if I’m sent home without testing: “Can you note in my chart that I asked about my heart and that it wasn’t tested?”
That second sentence isn’t about being difficult. It’s about making the decision visible. You’re allowed to ask directly whether an ECG or a blood test for heart damage has been done, and to ask why not if it hasn’t. If something still feels wrong after you leave, you’re allowed to go somewhere else.
And please don’t drive yourself. Calling 911 gets treatment started in the ambulance, which is one of the reasons the CDC tells you to call right away.
Use heart health month to know your own numbers
The other half of this is prevention, and it’s less dramatic but more useful over a lifetime. Ask your doctor at your next visit about your blood pressure, cholesterol, and blood sugar, and what your family history means for you. Those are the numbers that shape your risk, and many younger women haven’t had them checked in years. If all the red sweaters at work on National Wear Red Day last Friday nudged you at all, let the nudge turn into a checkup booked before spring. Regular movement helps too, and if you need a starting point that doesn’t require a gym, my no equipment home workouts are a good place to begin. Your doctor can tell you what’s right for your body.
Writing this made me a little anxious, and I think that’s appropriate. Learning the heart attack symptoms in women matters, but so does deciding in advance that you’ll speak up when they show up. Save the sentence in your phone today. Send this to the women you love, since a valentine with a script in it might be the most useful one they get this year.