Women are dying from a lesson that was never written for them

If the only heart attack you’ve been taught is a man clutching his chest, you’ve been taught an incomplete story.
And when the education is incomplete, women pay for it in hesitation, misreads, and delayed care.

Here’s the truth we need on posters, in waiting rooms, and in our group chats: heart attacks in women are not “rare versions” of men’s heart attacks. They can show up with a wider set of warning signs, sometimes building over days or weeks, and too often they’re labelled as stress, anxiety, or “just tired”.¹

This is us rewriting the default.

The “classic” signs were taught like men were the default

For decades, the “typical” heart attack story was modelled on male symptoms and male datasets. Women’s symptoms got stamped “atypical”, as if half the population was an edge case. A Journal of the American Heart Association editorial argued those labels should be retired, because the so-called “atypical” symptoms are common in women evaluated for myocardial infarction, and that language can contribute to missed and delayed diagnosis.¹

This isn’t about women being “confusing”.
It’s about a system that trained everyone, including women, to look for a narrow picture.

The numbers Australians should know

These are the kinds of stats that should stop a scroll:

• Around 20 Australian women die every day from coronary heart disease.²

• Cardiovascular disease causes about a quarter of all Australian deaths, with ischaemic heart disease the leading single cause of death in 2021.³

• Awareness is not improving, a Monash-led 2023 study found 1 in 5 Australians couldn’t name a single heart attack symptom.⁴

That’s why this matters. If we don’t recognise the fuller picture, we can talk ourselves out of urgency.

Yes, chest pain can happen, but it’s not the only warning sign

Chest pain or pressure is still the most commonly reported symptom in women and men.⁵ That’s important because we never want to tell women they “won’t” have chest pain.

But women can also experience heart attack warning signs that don’t look like the poster, including:⁵⁻⁷

• Shortness of breath (with or without chest discomfort)

• Unusual fatigue, often disproportionate to activity

• Nausea, vomiting, indigestion, or “reflux” that doesn’t settle

• Cold sweats

• Lightheadedness or dizziness

• Pain or discomfort in the jaw, neck, shoulder, upper back, or arms

• Upper abdominal discomfort

• Sleep disturbance

• A vague but persistent feeling that something is wrong

Permission slip you can keep: you’re not being dramatic, you’re paying attention.

The under-told part: the slow burn before the event

This is the piece most women wish they’d known sooner.

A landmark study (McSweeney et al.) found most women reported new or different symptoms more than a month before their heart attack, with fatigue and sleep disturbance especially common.⁶ In other words, sometimes the body starts whispering long before it has to shout.

That matters because “I’m exhausted and I can’t sleep” is also the soundtrack of modern womanhood. The signal gets buried in the noise of life lived under load.

So here’s a practical reframe:

Ask yourself: “Is this new or different for me?”

Not “Is this the worst pain of my life?”
Not “Can I push through?”
Not “Will I be embarrassed if it’s nothing?”

New. Different. Off. Persistent. Escalating.

If you’re worried enough to Google it, you’re worried enough to get checked.

Why women get dismissed (and why it messes with your confidence)

When women are told, “It’s anxiety”, “It’s stress”, “You’re run down”, it doesn’t just delay care. It trains women to distrust their own bodies.

And there’s evidence the gap isn’t just “in your head”:

• Women have been under-represented in cardiovascular trials for decades, which shapes guidelines, training, and triage expectations.⁸⁻¹⁰

• Australian registry data (CONCORDANCE) found women with STEMI were less likely to receive some invasive management and had about double the six-month mortality compared with men, even after adjusting for age and comorbidities.¹¹

• A Heart Foundation campaign story (Mandy Hall) describes being repeatedly told her symptoms were anxiety before later being diagnosed with a major blockage, and how that dismissal created shame and regret for seeking help.¹²

So if you’ve ever walked away thinking, “Maybe I’m overreacting”, please hear this:

Don’t downplay it to make other people comfortable.

The conditions that can blindside “healthy” women

Sometimes the reason a woman is dismissed is exactly the reason she needs to be taken seriously: she doesn’t fit the stereotype.

SCAD (spontaneous coronary artery dissection)

SCAD is a tear in the coronary artery wall, and it can occur in women who are otherwise healthy and active. It’s disproportionately female, with Australian and New Zealand registry data showing most SCAD patients are women.¹³ It can also be missed early, with research indicating a substantial proportion of cases are not initially diagnosed correctly.¹⁴

If you’ve ever thought, “But I’m fit, I’m young-ish, I don’t have risk factors”, SCAD is one reason that logic can fail.

MINOCA and microvascular disease

Women are also more likely to have heart attacks without the “classic” blocked artery picture on angiogram (MINOCA) or have microvascular dysfunction that doesn’t show up neatly on standard tests.⁷ The takeaway isn’t to self-diagnose, it’s to know that “normal” tests don’t always equal “nothing’s wrong”, and persistence matters.

Pregnancy and menopause are cardiovascular chapters, not footnotes

Women have risk factors that don’t exist in male physiology, and they’re not always on the standard checklist.

• Pregnancy complications such as preeclampsia, gestational hypertension, and gestational diabetes are associated with higher long-term cardiovascular risk.²

• Menopause matters because estrogen has a cardiovascular protective effect, and that protection drops as estrogen drops. Evidence links the menopause transition with less favourable changes in cholesterol and blood pressure profiles.⁷

If you’re perimenopausal or menopausal and you’re feeling “off” in a way that worries you, you deserve to be taken seriously. (Hot flushes are rude enough, we’re not adding “medical dismissal” to the list.)

The Heart Foundation recommends a Heart Health Check for women aged 45+ (or 30+ for Aboriginal and/or Torres Strait Islander women).²

A plain-language symptom map you can actually use

Save this. Share it. Send it to the woman who always says, “It’s probably nothing.”

If you notice any of these and it feels urgent or escalating:

• Chest pressure, tightness, fullness, or pain

• Shortness of breath

• Cold sweat

• Dizziness or faintness

• Nausea, vomiting, or indigestion that won’t settle

• Jaw, neck, shoulder, back, or arm discomfort

• Sudden, unusual fatigue (especially if new or out of proportion)

Treat it as urgent and get assessed. Women’s symptoms can be varied, and it’s better to be checked than to wait it out.⁵⁻⁷

How to advocate for yourself without having to become a medical expert

You deserve care that takes you seriously. These lines can help when you’re anxious, foggy, or being brushed off:

• “This feels new and different for me, and I’m concerned it could be cardiac.”

• “I understand there are multiple causes, but I’d like urgent assessment for heart-related causes as well.”

• “Can you document that I asked about a cardiac cause and what was ruled out?”

• “If symptoms change or worsen, what exactly should I do, and how quickly?”

• “I don’t feel safe going home without a clear plan.”

And if you’re supporting someone else: go with her. Be the calm, steady witness. Repeat the facts.

Rewrite the default, starting with us

When women’s symptoms are labelled “atypical”, it trains everyone to miss them. That’s not a women’s problem, it’s a system problem.¹

So we rewrite the default in the places that matter most:

• In the stories we tell daughters, sisters, mums, mates

• In what we save, share, and send

• In what we refuse to minimise

You’re not being dramatic. You’re paying attention.

If you think you or someone else is having a heart attack, call Triple Zero (000) immediately. Don’t drive yourself and don’t wait it out.

FAQs 

1. What are common heart attack warning signs in women?
   Women may experience chest pressure or pain, but also shortness of breath, nausea or indigestion, dizziness, cold sweats, jaw, neck, shoulder or back pain, and sudden or unusual fatigue.⁵⁻⁷

2. Can women have a heart attack without chest pain?
   Yes, some women report no chest pain, and may notice other warning signs instead.⁶⁻⁷ If you feel something is seriously wrong, seek urgent assessment.

3. Can heart attack symptoms build over days or weeks?
   Some research suggests many women report new or different symptoms weeks before the acute event, including fatigue and sleep disturbance.⁶

4. How do I tell reflux from something more serious?
   Indigestion-like symptoms can have many causes. The key is new, different, persistent, escalating, or accompanied by other warning signs (breathlessness, sweating, dizziness, unusual fatigue).⁵⁻⁷ When in doubt, get checked urgently.

5. What is SCAD and why does it matter for women?
   SCAD (spontaneous coronary artery dissection) is a tear in a coronary artery wall and is disproportionately seen in women.¹³ It can occur in people without “classic” risk factors, so awareness matters.

6. Are heart attacks more common in men than women in Australia?
   Cardiovascular disease is a major cause of death for women and men. In Australia, around 20 women a day die from coronary heart disease.²

7. What should I do if a doctor says it’s anxiety but I’m still worried?
   You can say, “This feels new and different, and I’m worried about a cardiac cause.” Ask what’s been ruled out, what to watch for, and what to do if it worsens. If symptoms escalate, seek urgent help.

8. What is a Heart Health Check and when should women get one?
   The Heart Foundation recommends a Heart Health Check for women aged 45+ (or 30+ for Aboriginal and/or Torres Strait Islander women).² Ask your GP.

9. Can menopause affect heart health?
   The menopause transition is associated with changes in cholesterol and blood pressure profiles, and reduced estrogen-related cardiovascular protection.⁷ Discuss your personal risk with a clinician.

10. When should I call Triple Zero (000)?
    If you think you or someone else might be having a heart attack, call Triple Zero (000) immediately. Don’t drive yourself and don’t wait it out.

References

1. Journal of the American Heart Association (2020) editorial arguing “typical/atypical” terminology should be retired for MI symptom framing.

2. Heart Foundation (Australia), Women and heart disease resources, incl. daily deaths estimate and Heart Health Check guidance.

3. Heart Research Institute (Australia), national CVD mortality share and leading cause of death (2021) summary.

4. Bray et al., Heart, Lung and Circulation (2023), Monash-led public awareness findings.

5. Heart Foundation (Australia) and American Heart Association consumer guidance, chest pain common but not only symptom.

6. McSweeney et al., Circulation (AHA), women’s prodromal symptom study, widely summarised in medical literature.

7. Peer-reviewed reviews on sex differences in MI presentation, menopause transition and CVD risk factors (as cited in brief, incl. PMC reviews).

8. Clinical Research in Cardiology (2025), female participation-to-prevalence ratio in cardiovascular trials analysis.

9. PMC (2025) analysis of cardiovascular trials 1997–2024 showing persistent underrepresentation.

10. AJMC review (2025) summarising underrepresentation persistence.

11. Khan et al., Medical Journal of Australia (2018), CONCORDANCE registry analysis across Australian hospitals, sex differences in STEMI care and outcomes.

12. Heart Foundation (March 2025), Mandy Hall campaign story/podcast quote re dismissal as anxiety.

13. Australia–New Zealand SCAD registry (JAHA 2025), sex distribution and characteristics.

14. American Journal of Cardiology (2025), SCAD misdiagnosis rates in women ≤55 (as cited in brief).