1. Home
  2. Heart Disease
  3. Early Heart Attack Symptoms  
Main content

Early Heart Attack Symptoms in Women

  • Can You Spot a Potential Heart Attack Months Ahead?

  • Many of us have experienced that moment. Perhaps we’re driving in traffic or working out at the gym when we feel a twinge in our chest, or an aggressive pulse. Or maybe we just don’t feel right. We might pause at these moments and wonder if our hearts are okay. Truth is, both men and women may notice subtle heart symptoms months before an actual heart attack occurs. And that reality can leave us wondering when it’s time to hightail it the doctor – and when it’s time to relax.

    We spoke with Sutter Health Cardiologist Zi-Jian Xu, M.D., FACC, Ph.D., to provide some perspective.

    Is it true that women can experience symptoms months before a heart attack actually occurs?

    That is true -- for both men and women. The symptoms can occur months or even longer sometimes, and you can have a very wide spectrum of symptoms. Some people may present for the first time with a heart attack after having no symptoms, while others may have symptoms a long time.

    What do these early symptoms typically look like?

    The majority of patients, including women, experience somewhat typical symptoms, such as radiating chest pain, heaviness or discomfort, heart palpitations, cold sweats and shortness of breath. However, women are more likely than men to experience atypical symptoms as well, which may include fatigue, a general sense of unease, vague discomfort, back or abdominal pain and declining stamina. Both types of symptoms can be experienced months before an actual heart attack occurs.

    Is there anything that distinguishes these symptoms? How can women know when the subtle, atypical symptoms could be heart disease?

    When we see patients and address these symptoms, it’s very important to look at the risk profile of each individual person. We look at family and personal history, blood pressure, cholesterol, age and disease history. From those risk profiles, we can identify patients as high, intermediate or low risk. Within the context of risk, we can evaluate symptoms. Are the symptoms typical or not? How does someone experience the symptoms? At rest, during exertion? Are they associated with emotional stress or cold weather? Are they happening in conjunction with other symptoms such as shortness of breath, rapid heart beating, cold sweats?

    Each person should really be aware of his or her own risk profile. Everybody should have a general idea of, ‘What is my chance of dying of a heart attack?’ We look at all these things to determine whether symptoms require further evaluation.

    These predromal symptoms don’t really sound like the “Hollywood heart attack” experience.

    There are two main ways that people present with heart attacks:

    • Sudden. A person may or may not have any symptoms previously, but all of the sudden a plaque ruptures, triggering a chain of events and a sudden heart attack.
    • The other is a more gradual progression of coronary disease. In these patients, an artery is getting narrower over time. When the artery is narrowed down to more than 70 percent, they will start to have these warning symptoms, especially with physical exertion. These are the cases where patients have symptoms, months ahead.

    What is the point at which a woman should talk to her doctor?

    Women should tell their doctors everything that they experience, especially when these are new symptoms. It’s important not to brush off symptoms and wait until they become severe. If a woman has a concern, she should bring it up and let the doctor evaluate her.

    What if her doctor assures her it’s just stress or fatigue? This seems to be a fairly common response to younger women?

    We need to achieve a balance of evaluation. If the patient doesn’t have other risk factors, the likelihood for her having significant coronary artery disease is low. It may not be appropriate to jump into testing. But the important thing for doctors is to always keep coronary risks in mind. Anyone experiencing symptoms that don’t go away or get worse, should go back to the doctor for further evaluation.

    Is there anything else you want people to know about early heart attack symptoms?

    We focus a lot on symptoms, but I think we all should really focus on prevention -- the lifestyle changes we can make, recognizing our risk factors and actively trying to reduce those where we can.

Take our free online health risk assessment