How women can tell if they’re headed for a heart attack

by Carolyn Thomas  @HeartSisters

When nurse-researcher Dr. Jean McSweeney from the University of Arkansas for Medical Sciences interviewed hundreds of heart attack survivors, she discovered something surprising: 95 percent of the women she interviewed actually suspected something was very wrong in the months leading up to their attack.

But even these early warning prodromal symptoms didn’t necessarily send women rushing to the doctor, as reported in Dr. McSweeney’s study published in the medical journal, Circulation.(1)  And for those women who did seek help early, doctors often failed to identify their problems as being heart-related.

If you experience the warning symptoms listed below – especially if the feelings are new, worse, unexplained, or you have other heart disease risk factors – call your doctor.  And if they’re severe, or you have any signs of an impending heart attack, call 911

Dr. McSweeney adds:

“Women die sitting at home. Any E.R. would prefer that you come in and not have a heart attack than have a heart attack at home, waiting to see if you get better.

“We could do a lot to give women longer lives and better-quality lives if we could help them recognize these heart problem signs before the first attack.”

Symptom: Unusual fatigue

♥  As Early Warning: Wake up tired. Difficult to carry out usual activities; gets worse over time.
♥  As Sign of Impending Heart Attack: Overwhelming exhaustion – too tired to do anything.

Symptom: Shortness of breath

♥  As Early Warning: Winded with little exertion. Improves when you stop.
♥  As Sign of Impending Heart Attack: Often the first symptom; continues or worsens.

Symptom: Mood changes

♥  As Early Warning: Fleeting feelings of anxiety for no reason. Goes away.
♥  As Sign of Impending Heart Attack: Anxiety occurs along with shortness of breath and doesn’t let up; what we call a “sense of impending doom”.

Symptom: Digestive changes

♥  As Early Warning: Frequent indigestion.
♥  As Sign of Impending Heart Attack: Terrible heartburn, often with nausea and vomiting.

Symptom: Weakness

♥  As Sign of Impending Heart Attack: No strength – like having the flu.

Symptom: Sleep disturbance

♥  As Early Warning: Trouble falling asleep or staying asleep.

Symptom: Chest discomfort

♥  As Early Warning: Pressure, pain, heaviness, fullness, ache, burning, or discomfort (or like a pulled muscle)
♥  As Sign of Impending Heart Attack: Common, usually through chest or back. May or may not be the “Hollywood Heart Attack”: crushing chest pain, pain radiating down either left or right armCarolyn’s Note: remember that in over 10% of heart attacks in women, there are NO symptoms of chest discomfort at all.(2)

Symptom: Other pains

  As Early Warning: Aching arms and hands; may have numbness or tingling (right, left or both)
♥  As Sign of Impending Heart Attack: Discomfort and/or pain in jaw, upper back, shoulders, neck, right, arms (left, right or both)

Other symptoms

♥  As Early Warning: Headaches and periods of blurry vision
♥  As Sign of Impending Heart Attack: Cold clammy sweat, pale skin


♥  As Early Warning:  Symptoms come and go, but may increase in intensity and number as attack nears.
♥  As Sign of Impending Heart Attack: You may have six or more different symptoms that become more intense and pile on top of one another.

Source:  Cleveland Clinic, American Heart Association, Heart and Stroke Foundation

♥    ♥     ♥

* In Dr. McSweeney’s research, women heart attack survivors identified these early warning prodromal symptoms in the weeks/months before a heart attack:

  • unusual fatigue (70.7%)
  • sleep disturbance (47.8%)
  • shortness of breath (42.1%)
  • chest discomfort (29.7%)

The most frequent acute symptoms reported during a heart attack were:

  • shortness of breath (57.9%)
  • weakness (54.8%)
  • fatigue (42.9%)
  • Acute chest pain was absent in 43% of women during a heart attack

♥    ♥     ♥

(1) Jean C. McSweeney. “Women’s Early Warning Symptoms of Acute Myocardial Infarction”. Circulation. 2003; 108: 2619-2623 November 3, 2003. doi: 10.1161/01.CIR.0000097116.29625.7C

(2)  S. Dey et al, “GRACE: Acute coronary syndromes: Sex-related differences in the presentation, treatment and outcomes among patients with acute coronary syndromes: the Global Registry of Acute Coronary Events”, Heart  2009;95:1 2026


NOTE FROM CAROLYN:  I wrote more about early warning cardiac symptoms in Chapter 1 of my book, “A Woman’s Guide to Living with Heart Disease”. You can ask for it at your local bookshop (my preference!) or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from my publisher, Johns Hopkins University Press (use the code HTWN to save 20% off the list price).


See also:

This is NOT what a woman’s heart attack looks like

How Does It Really Feel To Have a Heart Attack? Women Survivors Tell Their Stories

Is it a Heart Attack – or a Panic Attack?

Too Embarrassed to Call 911 During a Heart Attack?

Yale Heart Study Asks Why We Wait So Long Before Seeking Help in Mid-Heart Attacks



♥  PLEASE NOTE: I am NOT a physician and CANNOT advise you if you are experiencing any of these symptoms. Please see your doctor for a competent medical opinion if you are. 

COMMENTS FOR THIS POST ARE NOW CLOSED.  If your symptoms are unusual for you, do not hesitate to seek immediate medical help.

Read my site disclaimer for more info.


44 thoughts on “How women can tell if they’re headed for a heart attack

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  7. I’m worried that at times I have high blood pressure. I am a 28 year old female with four children. Last night I felt like my blood pressure was high. I had a severe headache and the day before my left arm had a pain up and down my arm. Today I felt like a thick book was sitting on my chest. And a little pain in my arm again. Any advice?


    1. Hello Gabriela – sorry to hear about your distressing symptoms. High blood pressure rarely has any symptoms – please consult a physician for medical advice.


  8. Hi. I’m a 33 year old female who just started exercising about a month ago after my husband suffered a mild heart attack. Now, I’m expierencing chest and back pains, hands having electrical shock waves fatigue. I also have asthma. Could I be leading up to a heart attack? It scares my eight year old daughter to lose mommy. I have no health insurance either. Very stressed. Any advice would be greatful. Thanks.


    1. Hello Pamela,
      No doubt having a hubby who’s just had a heart attack has suddenly made you and everybody who knows you feel hyper-aware of cardiac issues, and your lack of health insurance automatically lends a level of anxiety to even benign symptoms. Dr. Wayne Sotile cites research reporting that over 50% of family members of heart patients develop comparable ailments that may even require medical attention. Many symptoms, he explains, may result simply from the sheer stress of dealing with a loved one diagnosed with a serious heart condition. This is not to suggest that our symptoms are not real, or don’t require attention, by the way!

      Congrats on starting an exercise program – which as you know could certainly be responsible for some of your new symptoms at least in the early weeks as your body adapts. Nobody can predict which ones may or may not be heart-related at this point except a physician. You might start by tracking a list of symptoms, time of day, what activity you were doing both shortly before and when they happened, etc. If symptoms persist or get worse, please seek medical care.


  9. I have most of the symptoms but they don’t happen at the same. One day I’ll be having 2 of the symptom and then other days, I’ll be normal and then I’ll have the other symptoms. My mom thinks I’m fine. I really think she doesn’t understand. I can be heading to a heart attack any day soon. And I’m only 14 almost 15 in couple of days.


    1. Hi Katey – the good news is that it’s very uncommon for a young person to have a heart attack at your age, especially with varied symptoms over a period of time. Instead of telling yourself that you’re “heading to a heart attack” (which can just increase anxiety), why not focus on what you can absolutely control each day? For example: eat healthy foods, increase your daily exercise, maintain a healthy weight, do not smoke, make sure you get a good night’s sleep. Stop drinking beverages with caffeine and see if that makes a difference in how you feel, too. These are some things that people diagnosed with heart disease know will improve their cardiac health – with the added benefit of being smart lifestyle choices for everybody, not just heart patients.

      It may seem like your mother doesn’t understand simply because it can actually be hard to understand symptoms that come and go. If your symptoms do become worse, seek medical care. Good luck to you, Katey.


  10. This article has convinced me to see the dr. I’ve had about 75% of these symptoms for the past 6 months, slowly getting worse. This morning when I woke up I immediately felt “out of breath”. I’m 20 pounds overweight, don’t smoke, blood pressure slightly elevated, not on meds for it, and I’m 56. What an eye opener.


  11. I have all these symptoms and doctors tell me I’m fine! I wake up every morning with unusual fatigue. Terrible anxiety like something’s not right. A brief squeezing sensation behind breast bone tingling in back, pain in jaw and neck sometimes. Indigestion and heartburn that doesn’t go away with antacids. PVCs. I’ve had two stress echo tests within the past 4 months. Dr says I’m fine. Just stopped smoking 1 week ago cause I’m scared. I have an 8 month old and I’m scared I’m gonna die. Was in the hospital last month with pain under my left breast and arm pain and strange elbow pain. Stayed overnight and they said it was noncardiac. I’m really tired of feeling like I have to wait to die. My blood pressure tends to be on the low side and my overall cholesterol is 129 which my doctor says that’s normal. The cardiologist says I don’t show any signs of heart disease. Is there a test that I need that I haven’t had. I’ve had plenty of ekgs echocardiogram, blood panel to check to see if I’ve had a heart attack, cat scans of my heart and lungs. What should I ask for? I’m so tired of feeling like no one is taking me seriously and I want this resolved so I can be happy and healthy again.


    1. All morning I’ve been feeling short but painful bursts of squeezing in the center of my chest. Then tingling in my back. I’m losing my faith in doctors cause I don’t want to be told I’m fine. I know something isn’t right.

      Liked by 1 person

      1. Sorry you are experiencing these distressing symptoms, Joanna. Something is causing them – you just don’t know if they are cardiac-related or not. Your doctor may start with a questionnaire called the Duke Activity Status Index, which measures how well you’re able to do your daily activities. Other tests include pharmacological stress testing and a special type of coronary angiogram used to measure coronary artery flow reserve. Don’t give up – seek a second opinion if necessary.


        1. Carolyn, Thank you for replying. This has been isolating and debilitating cause I feel like I can’t live my life for fear of dying. I’ve been in and out of the hospital since after my son was born via c section cause of chest pain. I’ve been going to Counselling because of the anxiety these doctors keep telling me I’ve had. I try to explain that I get anxiety after these distressing symptoms begin. They injected dye twice with two cardiac ct scans which they say all looks good. My cardiologist says after the echo that my heart looked great. Blood flow was great. I know I said that in my earlier post. It’s just unnerving that I’ve had every test out there except an angiogram and all is well.

          I took a look at that Duke index online and I can do these daily activities without shortness of breath but running no. When I was smoking it was hard to walk up steps and stuff but after a few days of not smoking my heart hasn’t been racing that hard when I take laundry up and down the stairs.

          I just started walking last week. Once a day for 15 mins till I build some cardio and stamina then I’ll extend it. I’ve done it twice already and pushed myself hard. I wasn’t winded but did experience a pvc or two the cardiologist said that my pvcs are benign. Sometimes when I eat, my heart races and I feel like I’ve run a marathon. I’ve lived with some of this for years but the chest pain is recent. I was a ballet dancer most of my life but in the past 6 or 7 years, I’ve had stress, anxiety, I drank more and smoking on and off for ten years. When I was pregnant at 37 with my son, I quit cold turkey and had horrible withdrawal symptoms. I started back up in December when my mother was hospitalized with chronic atrial fibrillation. She passed away in Feb and I was chain smoking for a month. I don’t want to die so I quit cold turkey again. This is hard.

          I have two beautiful children and a wonderful husband. I know I have so much that I want to do in my life. Oh, can hypotension cause squeezing sensations in chest? I just feel like if I go back to the hospital or call my doctor they’re gonna tell me it’s anxiety. Maybe. But I’m not completely sure. I’m scared that the smoking has done permanent damage and I’m only 38! Lol.


          1. Hello Joanna – only a physician can tell what’s going on. You’ve already made some good decisions (quit smoking, seeing a therapist, walking every day) and have good Duke Activity Status Index scores except for running, but that’s not at all unusual in a smoker. All positive steps – congratulations! You’ve also had some major life crises you’re dealing with including your mother’s death – and as you know, anxiety can certainly mimic heart disease symptoms as a vicious cycle: anxiety causes cardiac symptoms, and cardiac symptoms make us feel anxious. Please don’t hesitate to go back to your doctor to get answers.


  12. Hi thanks for this article. I had been diagnosed with a 15% infraction (ejection fraction?) and cardiomyopathy also heart disease heart failure and high blood pressure. I am 42 and before I was diagnosed I waited three days, I thought I pulled a muscle but that was not the case. I visited the hospital the other day because of chest pains; they went away with medication but everything showed normal and I am having chest pain but mild again. My cardiologist is wanting me to wear a heart monitor for a day and have a echocardiogram test done.


    1. Hi Linda – that’s quite the list of cardiac issues you have, and at such a young age. Your cardiologist is being careful – good idea to follow his recommendations.


  13. Hi Carolyn,

    Thank you for this article.

    I’ve been getting pre-heart attack like symptoms for the past few months. But even doctors aren’t sure whether they are heart related symptoms or due to some other unknown disease.

    I’m 28 years old, had severe dizziness 2 months ago and occasional numbness in my left arm (both are now mild), I’m getting dull chest pains on top of left breast that last for a few seconds each time that come and go, I’ve been getting shortness of breath lately too and had a few episodes of severe palpitations that woke me up from sleep (they began as mild palpitations a few months ago). In the past few days I’ve had mild back pain and feel as though there’s a lump in my throat whenever I swallow, plus mild nausea that comes and goes.

    I’ve been to the ER 3 times, each episode they couldn’t find anything because they said my BP, ECG and blood tests looked fine and sent me home. I’ve seen 2 cardiologists, had stress test, echo, chest x-rays, 24 hr Holter monitor test, multiple ECGs done, had lung x-rays and lung function tests (for the shortness of breath to rule out pulmonary embolism), multiple blood tests to rule out autoimmune diseases, tried various prescriptions to rule out asthma, indigestion, heartburn and allergies. They have found nothing.

    To make sure it wasn’t anxiety, I even went to a psychologist to see if I am a hypochondriac – he diagnosed me as perfectly normal. I am also not stressed in any way and I eat pretty healthy and exercise regularly. The only tests I haven’t done are angiogram, cardiac event monitor and MRI – eventually my doc will send me to them.

    No matter what I do, the symptoms just won’t go away. I’m worried that it could be heart related and no hospital or doctor will pick it up. Stories like Jana and John’s scare me, because my tests have all come back clear and fine, yet my symptoms remain.


  14. These stories… WOW! What an inspiration to women and what a message. Thanks for sharing, I think the more women know, the more lives that will be saved.

    Not picking on men, BUT women are stronger when it comes to pain… We have given birth, We have menstrual cramps, menopause.. our backs always hurt.. We are famous for wearing eye glasses… We load groceries, walk dogs, mow our lawns, pick up our children…constant day after day of lifting and pulling. Headaches? Of course… that is just a Motrin thing (we think). Sweats? Nothing… just getting older.

    How in the world do we know when to take it seriously? Reading these postings will help. I think one of the most important things standing out in these postings is that woman have gone in, they felt something wrong, and they tried to do something about it. They were told “it is all in your head”, “Common symptoms for a woman your age”…

    There is one thing that women have and that is a 6th sense, intuition, gut feeling… whatever you want to call it. When it speaks to you… LISTEN.

    If your Dr. does not give you the answer you are looking for, the service you deserve… find another one. Don’t give up. That inner voice of yours is rarely (if ever) wrong.


    1. Excellent advice for all of us, Rachel. As I like to tell the women in my heart health presentation audiences: YOU KNOW YOUR BODY! You KNOW when something feels ‘just not right’! Ask yourself what you would do next if these same symptoms were happening to your daughter or your sister!”


  15. Hi Carolyn, I just want to say thank you for this blog. I have a little different heart problem, myocarditis that led to ventricular tachycardia, ablations, and an ICD, but so much of what you talk about is familiar to me as a 33 year old mom, wife, and professor. I especially like your “tough love” that I need to get over myself – but also take care of myself.

    This post struck a chord because a month before I got sick with myocarditis three years ago, I had the thought, “I should do more to make sure we are eating heart healthy!” funny how these things pop into our heads.

    Thanks again, this site is so helpful especially for younger women who are new to the heart disease world.


    1. Thanks so much for sharing your comment here, Nicole. Your story is truly amazing – and at such a young age! I bet you knew very few if any women your age in the same boat back then – a very isolating reality.

      So interesting that you suddenly got the urge to begin planning heart-healthy meals one month before your cardiac event! It would be nice if we all could think like this without it being a prodromal symptom!

      And I’m thinking the “tough love” you mention might be this post? Or this one?


  16. Congratulations Carolyn! I gave my first presentation, it went well! I will be doing presentations to larger groups once I learn Power Point.

    Thanks for your website and great advice.


  17. The information you present is so vital! Thank you so much for helping our “Heart Sisters” become better communicators.


  18. In addition to all of the above, I had a twitch on the left side of my face, very abnormal reflexes, and a heart rate of 150 bpm.

    Still, I was misdiagnosed (with depression and back strain) by three doctors.

    The first doctor accused me of being a drug addict. I went to ER where I was diagnosed with back strain. I told the third doctor I felt like I was dying and I was told I needed a psychiatrist. The following day I went down with sudden cardiac death X, cardiogenic shock, seizure, and stroke.

    While in CCU on every life support system known to mankind (my family was told I probably would not live) my daughter came home to a message on the answering machine from Doctor No. 3 saying I was in “perfect health.” Dr. No. 1 was fired, and Doctor No. 3 (Chinese) was nowhere to be found. He evidently left the country.

    I am very happy with my doctors now–I have The Best–but 12 years later I am still angry about it.

    I had an almost fatal MI that should have never happened at all, lost my ability to walk, and was bedridden for almost three years. I should have gone to another ER at another hospital, but I had never really been sick and I had no clue it was my heart.

    Die 3 times and learn . . .


    1. Yoiks!!! That is some cautionary tale, Beamie. Your story reads like the tragic Keystone Cops of medicine – do these docs not TALK to each other or read chart notes?!

      PS that face twitch symptom of yours reminds me of a woman I met at Mayo Clinic whose only heart attack symptom was when her lower lip went numb. Not that I want every person whose lip is numb to run screaming to the E.R. when reading this…

      I’m just saying. 😉


      1. My mouth and tongue went numb. I had a horrible sense that something was wrong. Thankfully, I was admitted for observation, despite clear EKG & CT scan. By morning, I had profound weakness & nausea that would not respond to medication, and I could not stay awake. I never had chest pain, but was told I was having a heart attack after multiple lead checks and finally another EKG that showed an 8 mm ST elevation. I was flown out for an emergency catheterization and diagnosed with Prinzmetal’s Angina, by exclusion.


  19. In my 6 years of working IVCU I found a much higher percentage of women did not experience the classic signs of heart attack. Most had a dull back ache.


    1. And that very common experience may help to explain why women blow off their symptoms and delay seeking help. Who’s going to rush to the E.R. because of “dull back ache”? More on this phenomenon from Oregon research on women’s treatment-seeking delay behaviours here. Thanks for your perspective, John.


      1. Great article!

        I had severe lower back pain a few days before the pressure in my chest woke me up in the middle of the night. I felt terrible, anxious, uncomfortable. But I have a bad back so I thought it was a flare up. I continued to feel bad and to take Tums for what i thought was heartburn too.

        The following week I was sent for emergency cath and angioplasty, although EKG and BP were fine. I had 95 and 85% blockages in LAD and RAD. Here I am 3 stents later.


        1. Thanks for sharing your story, Magda. No wonder you blew this off as a back problem, given your history with a ‘bad back’. Thank goodness you were finally sent to the cath lab DESPITE your “normal” EKG. It means that somebody was actually paying attention to your reported symptoms. Hope you’re feeling better now.


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