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New Delhi: Heart disease remains the leading cause of death among women, yet heart attacks in women continue to be missed, delayed, or misinterpreted—even in clinical settings. This isn’t because symptoms are rare. It’s because they often don’t look the way we’ve been taught to expect. For decades, the “classic” heart attack image has been shaped around men: crushing chest pain, left arm numbness, dramatic collapse. Women’s bodies don’t always follow that script—and the consequences of this mismatch can be dangerous. Dr. P L N Kapardhi, Clinical Director, Cath Lab & Sr. Interventional Cardiologist, CARE Hospitals, Banjara Hills, Hyderabad, decoded this for us.
Most medical textbooks and public awareness campaigns were built on male-centric data. As a result, symptoms that don’t involve sharp chest pain are often labelled atypical. In reality, for women, these symptoms are often typical. Women are more likely to experience:
Unexplained fatigue or weakness
Shortness of breath without chest pain
Nausea, indigestion, or vomiting
Jaw, neck, back, or shoulder discomfort
A sense of anxiety or impending doom
Because these signs overlap with common, non-cardiac complaints, they’re easier to overlook.
Why are symptoms misread in hospitals
Even in emergency settings, women’s symptoms may be attributed to:
Acid reflux
Anxiety or panic attacks
Musculoskeletal pain
Hormonal changes
Stress or exhaustion
This is not always due to negligence. It’s often the result of unconscious bias and diagnostic habits shaped by years of male-focused cardiac data. In some cases, women themselves minimise symptoms, delaying presentation until the condition worsens.
The role of biology
Women’s hearts and blood vessels behave differently.
They are more likely to experience:
Microvascular disease (blockages in smaller vessels not seen on routine angiograms)
Plaque erosion rather than large artery blockage
Hormonal influences that affect blood vessel tone
Standard tests may appear “normal,” even when a woman is actively having a cardiac event.
This makes diagnosis more complex and requires a higher index of suspicion.
Age and risk perception
Another reason symptoms are dismissed is age. Heart disease is still wrongly seen as a post-menopausal or elderly issue. Younger women presenting with chest discomfort or breathlessness are often considered low-risk, despite rising rates of heart disease linked to stress, diabetes, smoking, autoimmune conditions, and pregnancy-related complications.
Risk doesn’t always look dramatic on paper.
The cost of delayed recognition
When diagnosis is delayed:
Treatment windows are missed
Heart muscle damage increases
Recovery becomes longer and more complicated
Long-term heart function may be compromised
Women are more likely than men to experience worse outcomes after a heart attack—not because the disease is more aggressive, but because it’s recognised later.
What women should watch for
Women need to trust subtle signals, especially when symptoms are new, unexplained, or persistent. Red flags include:
Sudden fatigue out of proportion to activity
Breathlessness while resting or doing routine tasks
Chest pressure, tightness, or heaviness—even if mild
Pain spreading to the jaw, back, or shoulder
Symptoms that don’t improve with rest
Listening to the body early saves lives.
What healthcare systems must change
Better outcomes require:
Greater awareness of sex-specific symptoms
Broader diagnostic criteria
Willingness to investigate beyond “normal” test results
Clear communication that women’s symptoms are valid
Medical training is improving, but awareness still needs to catch up.
A shift in how we talk about women’s hearts
Women’s heart attacks aren’t silent—they’re misunderstood.
Recognising that symptoms may look different is not about lowering diagnostic standards; it’s about applying them more accurately. When women, families, and healthcare providers stop expecting heart attacks to look the same in everyone, outcomes improve dramatically. Heart disease does not discriminate by gender. Our understanding of it shouldn’t either.
