7 lesser-known signs of heart trouble in women

Heart disease is the leading cause of death among women and killed more than 314,000 women in 2020, according to the Centers for Disease Control and Prevention. A 2020 report in the journal Circulation found that women are more likely to die from a heart attack or heart failure than men.

“Women often ignore symptoms of heart disease, which was historically felt to be a ‘man’s disease’ — this is far from the truth,” says Dr. Briana Costello, a general and interventional cardiologist at the Texas Heart Institute’s Center for Women’s Heart & Vascular Health.

With that in mind, here’s what cardiologists want women to know, including symptoms of poor heart health they shouldn’t ignore.

A ‘silent’ issue in women

Though awareness of heart disease in women has increased, it’s still sometimes referred to as a “silent” condition. And frustratingly, there has been a lack of gender-specific studies on risk factors for heart disease in women, researchers from Houston Methodist’s DeBakey Heart & Vascular Center pointed out in a 2017 study.

But other issues may be at play. “While we think sometimes heart disease can present differently between men and women, people are different and may describe pain and discomfort differently and may not recognize some of these symptoms related to the heart,” says Dr. Deirdre Mattina, a Cleveland Clinic cardiologist.

Biology and physiology complicate this issue, she says. “The heart doesn’t work in isolation. It’s connected to other major organs. Our heart pumps directly from our lungs and feeds into our vascular system.”

So, many women may link “shortness of breath” to respiratory or lung issues rather than heart — but this red flag is one of many often-ignored symptoms of cardiovascular problems in women. Here are the other ones to keep in mind:

Top signs of cardiovascular trouble

Mattina says it’s important to be aware of some of the lesser-known signs of cardiovascular issues in women. One of the most important things to look out for: a change. “If there is a symptom that is new and has changed in frequency, intensity or duration, that’s probably something that needs to be checked out,” Mattina says. Others include:

1. Fatigue

Mattina says women may shrug off fatigue, particularly if they’re busy, burned out and caring for a family. “Women are always running around,” Mattina says. “They control the care for so much of the rest of the household, so they focus less on their health.”

But fatigue could be one of the first signs of heart issues in women. “It could be that they are not getting enough blood flow to the heart arteries or the heart is not squeezing appropriately,” Mattina says.

What does “fatigue” mean, especially for someone who may be accustomed to feeling tired? It’s all about your baseline.

“If you used to feel well-rested and there’s not an acute reason like you’ve pulled some all-nighters, those are the things you’d want to talk to with your provider,” Mattina says.

2. Shortness of breath

Exercise tolerance is a good barometer to help you measure shortness of breath. For example, Mattina says you may think, I was able to mall walk every day with my friends, and now I am having to stop, sit and rest.

“Those would be things we would look into a change in the heart function,” Mattina says.

3. Leg swelling

Unexplained leg swelling can be a sign of venous insufficiency.

“(This) means the blood can’t pump up to our heart quick enough,” Mattina says. “That can also be seen when the heart is not squeezing appropriately with a form of heart failure, and so we would begin a work-up if that was new or progressive in a patient.”

4. Pain in the chest that can be mistaken for heartburn

The stomach and heart sit close to one another, so people can confuse typical indigestion with something more severe called angina, which Mattina says is pain from decreased blood flow to the heart. If taco night was never an issue for you and suddenly is, take note.

“If you are a person that ate tacos your entire life and never had indigestion and all of a sudden have it every day for a week, that could be something considered unusual and that you want to investigate,” Mattina says.

5. Dizziness and palpitations

If your heart is beating fast at rest and you’re feeling dizzy or nauseous, don’t try to power through. “That could point us to a rhythm disorder if you are feeling your heart racing,” Mattina says.

6. Jaw or back pain

Dr. Bobbi Chapman, a cardiologist and the medical director of heart failure at Abiomed, says pain in these areas is easy to overlook but may be the only symptom of a heart attack in women. Unexplained pain on the left side is particularly troubling. The American Heart Association also lists this symptom as one that women should keep in mind.