The Hidden Reality of Women’s Heart Disease and the Gender Gap in Cardiac Care

Here’s a fact that might surprise you. Heart disease is the No. 1 cause of death in women, surpassing all cancers combined. Yet many still believe heart attacks are primarily a men’s health issue.

That misconception can be dangerous. Women often experience heart attack symptoms differently than men, and those differences can lead to delayed diagnoses or symptoms being dismissed altogether. Women are natural caregivers, whether as mothers, sisters, partners, or daughters, and they often put their own health concerns last.

OU Health cardiologist Dr. Akshaya Gopalakrishnan, M.D., clinical assistant professor of medicine in the Department of Cardiology at the University of Oklahoma College of Medicine, wants women to understand their risk and recognize the warning signs that could save their lives.

Heart Attack Symptoms in Women Look Different

You’ve likely heard about the classic heart attack warning signs that include crushing pain in the chest that spreads to the arm or jaw. But Dr. Gopalakrishnan says women rarely experience the textbook presentation.

“Compared to men, women rarely have the classic chest pain radiating to the left arm or jaw,” Dr. Gopalakrishnan said. “Rather, they have multiple symptoms like chest pain that can be difficult to localize, or in the absence of chest pain, [they have] nausea, vomiting, several days of fatigue or back pain.”

These symptoms are easily attributed to other causes like stress, heartburn, aging, or anxiety. It’s not uncommon for women to go to the emergency room later than they should as they initially dismissed what they were feeling. American College of Cardiology and American Heart Association guidelines explicitly state that women may present with chest discomfort plus fatigue, shortness of breath, nausea, jaw pain, or back pain.

Why Women Are More Likely to Be Misdiagnosed

For decades, medical research and diagnostic guidelines were based mostly on men.

Symptoms like fatigue, nausea, vomiting, back pain, and jaw pain were labeled “atypical,” implying they were rare or less important. When a woman’s symptoms don’t match the male-based standard, doctors may be less likely to suspect cardiac disease.

Dr. Gopalakrishnan recalled a patient case that illustrates this challenge.

“A young woman around 40 came in with several days of back pain, nausea, and vomiting,” she said. “Her troponins [proteins found inside heart muscle cells] were elevated, and her EKG showed changes indicating a heart attack. The previous day, she had gone to an urgent care where she received symptomatic treatment for her back pain and nausea.”

The woman’s diagnosis of a heart attack was delayed for a day because her symptoms weren't the classic version.

Healthcare systems can improve outcomes for women by using diagnostic guidelines designed for them, ordering imaging tests when early results don’t provide clear answers, and educating clinicians to help them recognize unconscious bias when treating women with heart problems.

Risk Factors Women Should Know

Beyond traditional risk factors like high blood pressure, diabetes, and cholesterol, women face unique risks tied to their reproductive and hormonal health. Dr. Gopalakrishnan describes pregnancy as “a stress test for each woman.” Complications during pregnancy can be early warning signs of future heart disease.

Other risk factors to discuss with your doctor include:

• High blood pressure during pregnancy (gestational hypertension or preeclampsia)
• Diabetes during pregnancy (gestational diabetes)
• Early labor or early separation of the placenta (placental abruption)
• Autoimmune conditions such as lupus, rheumatoid arthritis, psoriasis, or Sjögren’s syndrome
• Cancer treatment requiring chemotherapy
• Early or premature menopause

When women go through menopause early, their bodies have less estrogen. This can make their blood vessels work less well and change the way their bodies handle cholesterol in ways that are harmful Dr. Gopalakrishnan said. Autoimmune diseases are chronic inflammatory states, which can quickly lead to problems with the heart and blood vessels or “accelerated atherosclerosis.”

If you have any of these conditions, talk with your clinician about whether adding a cardiologist to your care team makes sense.

Protecting Your Heart Health

For women in their 40s, 50s, and beyond, Dr. Gopalakrishnan offers straightforward advice: “Know your history, listen to your body, ask for early screening, adapt lifestyle changes, and spread awareness,” she said.

Early screening may include checking blood pressure and cholesterol, reviewing pregnancy history, or discussing whether imaging or stress testing is appropriate. Lifestyle changes can be as simple as choosing heart-healthy foods, increasing physical activity, managing stress, and prioritizing sleep.

If you’ve been experiencing subtle symptoms like fatigue, occasional shortness of breath, or discomfort you’ve attributed to stress, don’t dismiss them.

“Many women tend to brush it off, attributing the symptoms to aging, stress, work, or anxiety, but these could actually be early signs of heart disease,” Dr. Gopalakrishnan said. “Don’t neglect it. Get your heart checked today.”

Comprehensive Cardiac Care for Women at OU Health

OU Health, the University of Oklahoma’s academic health system, offers a dedicated team of cardiologists and subspecialists who assess, screen, and educate women about their individual risk. The program provides advanced diagnostics, prevention strategies, and treatment for conditions specific to women’s cardiovascular needs and risk factors.

For women with high-risk pregnancies, OU Health cardiologists trained in cardio-obstetrics work alongside maternal-fetal medicine physicians as a multidisciplinary team to provide comprehensive care throughout pregnancy and beyond.

“Your heart speaks. Are you listening?”

If you’re concerned about your heart health or have questions about your risk factors, contact OU Health’s Heart & Vascular Clinic today to schedule a screening with our cardiac team.