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Chest Pain in Women: Why This Symptom and Others Should Never Be Ignored


Women are more likely to have a heart attack without chest pain than men, and they are more likely to experience other symptoms that men don’t. Women also tend to dismiss sporadic chest pain and other subtle symptoms that could be an indicator of heart disease.

“While men are more likely to suffer heart attacks and at a younger age than women, roughly 24 percent of women in emergency rooms with chest pain are found to have coronary artery disease,” explains Jonathan Fialkow, M.D., chief of cardiology at Baptist Health Miami Cardiac & Vascular Institute and Chief Population Health Officer at Baptist Health South Florida. “Women tend not to think of themselves as at risk for coronary artery disease and heart attacks. They don't often seek care for themselves as often as men do, or as often as women push their partners to do.”

Jonathan Fialkow, M.D

Jonathan Fialkow, M.D., Chief Population Health Officer for Baptist Health and chief of cardiology at Baptist Health Miami Cardiac & Vascular Institute.

Dr. Fialkow hosts a new Baptist HealthTalk podcast, Chest Pain in Women, featuring vital information on the impact of heart disease on women with a focus on chest pain. His guest is Andrea Vitello, M.D., cardiologist at Baptist Health Miami Cardiac & Vascular Institute.

More than 60 million women (44 percent) in the U.S. are living with some form of heart disease, which is the leading cause of death for both men and women, according to the U.S. Centers for Disease Control and Prevention (CDC).

“Women in general are very quick to dismiss their symptoms as being concerning, sometimes even at the expense of their own health,” said Dr. Vitello. “They say: ‘Oh, it's nothing. It'll go away.’ And that, in general, is a very dangerous approach to one's own healthcare. Unfortunately, that does happen quite a bit.”

While women are less likely to experience chest pain as a warning sign of a heart attack, it is something that needs the attention of a physician as soon as possible.

“There’s a number of causes of pain in the chest for women, and some of them are cardiac related,” explains Dr. Vitello. “Some that we get very concerned about are those that lead to heart attacks, but other cardiac causes of pain in the chest that are not heart attacks are, for instance, pericarditis, and that's just an inflammation of the lining around the heart.”

Other causes, she adds, could include “aortic syndromes, where there may be a life-threatening tear in a blood vessel, a very large blood vessel, the aorta.” Some potentially less dangerous causes of pain in the chest in women can include gastrointestinal causes, acid reflux disease or esophageal spasm. “Those are certainly treated very differently.”

There are several less urgent causes of chest pain in women that can be diagnosed after all other more serious causes are dismissed.

Andrea Vitello, M.D

Andrea Vitello, M.D., cardiologist at Baptist Health Miami Cardiac & Vascular Institute.

“There are other symptoms that can certainly mimic a heart attack, but still you need to consider --  these are more of a diagnosis of exclusion once everything else has been more completely evaluated,” explains Dr. Vitello. “Those include anxiety and depression and sometimes panic attacks. But again, this is after everything else has been completely excluded as not being dangerous -- then it might certainly come down to anxiety.”

Sometimes pain in the chest may indicate coronary artery disease – and acts like a warning sign for a future cardiac event if the condition is not treated. Coronary artery disease develops over the course of one's lifetime that gradually causes a buildup of atherosclerosis, which is a narrowing and hardening of the blood vessels due to accumulation of fat, cholesterol, and other substances called plaque.

“Some of the symptoms that people in general develop with heart attack, and also including women, include chest pain, chest pressure or tightness in the chest. But in addition to that, women may also develop some other maybe less obvious symptoms that can sometimes be mistaken for something else. And it can actually mean that there might be something wrong with how blood supply is getting to the heart.

“And some of these other symptoms that women, in particular, should watch out for can include difficulty breathing. If you feel like you've just run a marathon but you really haven't, that's a warning sign that maybe there's something going on with the cardiovascular system.”

Some other symptoms include nausea and vomiting, fatigue that's unexplained –"not just because you didn't have a good night's sleep, but really just can't get enough energy to do usual activities that would otherwise not seem very difficult to do,” adds Dr. Vitello. “Breaking out into a cold sweat, getting pain in the back or in the jaw. Sometimes feeling dizzy or lightheaded to the point that you almost might pass out, and sometimes heart palpitations as well.”

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