Heart attacks in women: How we're missing a beat on women’s heart health

A quick response can save a life in the event of a heart attack. But women are more likely to dismiss their symptoms — often different from the chest-clutching stereotype — because they see it as a condition that predominantly affects older men

Fri, 26 Sep, 2025 - 01:00

Sharon Ní Chonchúir

Sharon Butler’s 46th birthday was very nearly her last.

The now 53-year-old from Mahon, Cork, celebrated by having lunch with her daughter and treating herself to a new pair of shoes: “When I got home, I decided to try the shoes on again, and as I leaned forward, I got a sudden pain in my chest. I thought it was indigestion, but my daughter panicked, telling me I had turned a funny colour.”

Butler reassured her daughter that it had to be indigestion. But her daughter was not convinced. She rang Butler’s husband, who was ideally placed to make a medical assessment.

“Back then, James and I were in the middle of a stressful time in our lives,” says Butler. “We had both decided to change careers and I had recently done a law degree and a master’s in criminal justice and started a new job as a legal cost accountant, while he had left his plumbing job to train as a doctor. We had hardly any money and were working so hard. Things were hectic.”

When her husband heard that Butler had a pain in her chest, had turned grey, and was getting pins and needles in her hands, he urged her to go to hospital.

“He thought I was having a heart attack,” she says. “But I wouldn’t go. I was able to walk around, so I thought I was fine. The picture I had in my mind of someone having a heart attack was of an older man clutching his chest in agony. That wasn’t me. Surely what I had was indigestion?”

Faced with his wife’s refusal to take her situation seriously, Butler’s husband rushed home, encouraged her to take some aspirin and took her to the hospital. She remembers feeling “so embarrassed, thinking we were wasting everyone’s time”.

Six hours, blood tests, and an electrocardiogram test later, Butler’s husband was proven right.

“I couldn’t believe it,” she says.

That was the bad news. The good news was that because her husband had rushed her to hospital, she could expect to make a good recovery.

“His fast reaction meant the damage done to my heart was minimal,” she says.

Susan Connolly, a consultant cardiologist at University Hospital Galway, explains that a heart attack occurs when one of the three arteries supplying the heart’s muscle pump becomes blocked.

The most common reason for this is plaque rupture. Plaque is the fatty substance that can build up on the inner walls of our arteries as we age, which Connolly compares to “crème brûlée — hard on the outside and soft in the middle”.

“The top of that crème brûlée can crack and the soft plaque combines with the blood, which sets off a clotting reaction that eventually blocks the artery,” she says.

When this happens, it is vital that we react quickly, as the blockage reduces or cuts off the blood supply to the heart muscle.

“And time is muscle,” says Connolly. “Doctors can administer drugs after a heart attack to help the heart muscle recover, but the longer the wait before those drugs are administered, the more muscle dies and the more irreversible damage is done. People can die.”

These serious consequences are why we need to be aware of the warning signs of a heart attack.

Seeing the warning signs

In 80% of cases, the most significant warning sign is some form of chest discomfort, says Róisín Colleran, consultant cardiologist with the Mater Private Network in Dublin.

“This can be pain, but it can also feel like tightness or pressure,” she says. “It can be mild, and I’ve heard women describe it as similar to the feeling you get if your bra strap is too tight. But it can also be severe enough for it to feel like an elephant is sitting on your chest.”

For others, the pain might not be in their chest at all, but in their neck, shoulder, the top of their stomach, their back or down either arm.

“I’ve had patients whose only symptom was jaw pain,” says Connolly.

Some people experience no discomfort or pain at all: “Instead, they might feel nauseous or start vomiting, They might become breathless or dizzy. Extreme tiredness can be a symptom and so can hot or cold sweats. I’ve even had patients say they feel overcome by a feeling that something awful is about to happen. Usually, these symptoms occur in combination but sometimes there is only one.”

The sheer variety of these symptoms can make it difficult for those without medical training to understand what’s happening.

“That’s why so many people who have heart attacks initially think they have indigestion or are simply tired or stressed,” says Connolly. “It’s why they stay home when they should go to hospital. If I could get one message out to the public, it would be not to do that. If ever something feels wrong, get it checked out.”

Róisín Colleran, consultant cardiologist with the Mater Private Network in Dublin.

Colleran adds that this is especially pertinent if you experience pain in or around your chest.

“If it goes on for more than 15 minutes, seek medical attention,” she says.

Connolly is particularly eager for this message to reach women. In her experience, she thinks they are more likely to dismiss their symptoms as Butler did: “One of the reasons for this is because they do not perceive themselves as being at risk of a heart attack because they see it as a condition that predominantly affects older men.”

To further complicate the situation for women, men typically adhere to the chest-clutching stereotype, while women tend to present with more unusual symptoms.

Even if they do present differently, statistics show cardiovascular disease, which causes heart attacks and strokes, kills almost as many women as men. In 2024, it caused the deaths of 5,120 men and 4,474 women, accounting for one in every four deaths.

What may have caused the misperception that heart attacks don’t affect women as much as men is that women generally develop cardiovascular disease at a later age than men. This is because their high levels of oestrogen protect their hearts early in life.

“But as menopause approaches in a woman’s mid-40s, her oestrogen levels begin to fall,” says Colleran. “From then on, her risk of heart attack catches up with men’s.”

Women also have to contend with a gender bias within the medical system itself. US data published in 2018 reported that women with heart attack symptoms were less likely than men to receive aspirin, be resuscitated, or be transported to hospital in ambulances using lights and sirens.

A 2016 University of Leeds study used data from some 600,000 heart attack patients in 243 hospitals in England and Wales to show that women presenting with a heart attack were 50% more likely to be misdiagnosed than men.

“There’s definitely a bias there, and it can have serious consequences for women, as we know how crucial a quick diagnosis can be in the event of a heart attack,” says Connolly.

“That’s why I make sure all medical students at the University of Galway get at least one lecture on female heart health and how heart problems can manifest differently in women.”

Noticing a change

Cork University Hospital staff took Butler’s symptoms seriously and quickly diagnosed her with a spontaneous coronary artery dissection.

She describes this as “a tear that occurs in an artery wall and causes a heart attack”. It’s less common than a plaque rupture and happens to more women than men.

She stayed in hospital for five days and was given aspirin to thin her blood and a beta blocker, which she will take as a form of preventative medication for the rest of her life.

She was also advised on lifestyle changes to further support her heart health. She had been a smoker but had given up a year before her heart attack.

“I was told smoking had probably weakened my arteries and was warned never to pick up a cigarette again — and I’ve followed that
advice,” she says.

She also gets her blood and blood pressure tested regularly, tries to eat well, and aims to be physically active.

Now that she is menopausal, she is aware that she needs “to take even more care. And if ever anything goes wrong with my body again, I won’t delay. I’ll go straight to the doctor”.

Looking back, Butler can see that her heart attack has changed her. It led to her volunteering with the Irish Heart Foundation and now coordinating their ‘Her Heart Matters’ campaign.

But it also led to a change in outlook: “I was so stressed back then. James and I were broke and struggling. My mother had recently died, and I was grieving. I was holding all of that in and not sharing it with anyone. I think women are often like that. We may be good at looking after others, but we’re not always good at looking after ourselves.

“I’m trying to change that about myself. I share my problems and worries with family and friends. I try to make time for hobbies and things I enjoy, as well as exercise and eating well. I’m feeling all the better for it.”

Minimising your risk of heart attack or stroke

Developing science and growing awareness of healthy lifestyle habits are leading to significant improvements in cardiac health and in outcomes following a heart attack or stroke.

“I’ve worked in cardiology since 1998, and since then, the prognosis for patients with heart attacks has transformed,” says Connolly.

“Huge strides have been made in medication and in understanding the lifestyle habits that help us all lead long and healthy lives.”

Colleran explains that cardiovascular disease is “up to 90% preventable if we control our risk factors”.

Step one is finding out about our family history.“People who need to be particularly alert to risk are those with parents or siblings who have had heart attacks, especially if they had them early, before the age of 55 in men or 65 in women,” says Connolly.

Two is paying attention to risk factors such as diabetes, high blood pressure and cholesterol. Diabetes should be treated, while blood pressure and cholesterol should be measured regularly so that potential problems can be managed at an early stage.

“A recent TILDA study found that one third of older Irish adults have undetected high blood pressure,” says Connolly. “They don’t know they are at heightened risk of having a heart attack.”

A third step is adopting heart-healthy habits. “If you smoke, stop smoking,” says Colleran. Doing so will halve your heart attack risk within a year.

Connolly advises following a Mediterranean-type diet. “This means eating fish twice a week, red and processed meat in moderation, and lots of fruit, vegetables, nuts, and pulses, as well as cooking with olive oil and keeping your alcohol intake within the recommended range. Eating this way is cardioprotective and reduces your risk of cancer, dementia, and diabetes.”

Other recommended lifestyle changes include, aiming for at least 150 minutes of moderate-intensity activity per week; prioritising sleep by getting between seven and nine hours of sleep a night; managing your stress through practices such as mindfulness,
meditation, or a hobby you enjoy; and making time for social relationships. These measures have been shown to improve heart health.

Finally, be aware of the symptoms of a heart attack, and if you think you might be experiencing any of them, call 999 or 112 immediately.