Heart complaints in women: which symptoms the studies count, and when to contact a doctor

In this article you will read which heart complaints women report, how those differ from the complaints men report, what the studies counted in the weeks before an acute heart problem, and when you contact a doctor. That matters, because among patients aged 18 to 55 who sought help before being admitted for a heart attack, 53% of the women, against 37% of the men, reported that the care provider did not see the heart as the cause.⁠³ BioProfile’s heart and vascular scan gives you an indication of where you stand today in this area, as one of the 11 health areas the full scan assesses. This is not a diagnosis. It is insight, to see where you stand and to make better choices in your food and your daily life. Pointing to a cause is work for a doctor.

Heart complaints in women: which symptoms differ from those in men

A systematic review pooled 27 studies with 1,226,163 patients with a confirmed acute coronary syndrome. Chest pain was the most reported symptom in both sexes: 74% (95% CI 67 to 81) of the women and 79% (95% CI 72 to 85) of the men. Compared with the men, the women were more likely to have pain between the shoulder blades (OR 2.15), neck pain (OR 1.83), jaw pain (OR 1.75) and nausea or vomiting (OR 1.64), and less likely to have chest pain (OR 0.70).⁠¹

Put simply: chest pain is the most reported complaint in women too, and the difference lies in what comes with it. In a younger group of 2,009 women and 976 men, women came in more often than men with three or more additional symptoms (61.9% against 54.8%).⁠³

What the weeks before an acute heart problem looked like

Of 515 women with a heart attack, surveyed 4 to 6 months after discharge from hospital, 489 (95%) reported symptoms in the period before the attack. More than a month beforehand, unusual fatigue (70.7%), disturbed sleep (47.8%) and shortness of breath (42.1%) were the most reported, while chest discomfort was reported by 29.7%. During the attack itself, shortness of breath (57.9%) and weakness (54.8%) were at the top, and acute chest pain was absent in 43%.⁠²

Those complaints were recalled from memory months later, so they say what the women noticed in hindsight. Tiredness and broken sleep belong to ordinary weeks too, and that is why either one on its own says little.

Chest complaints without a narrowed coronary artery

In the WISE study, of the 916 women referred for coronary angiography because ischemia was suspected, 567 had no obstructive coronary artery disease, consistent with suspected INOCA (mean age 55.6 ± 10.8 years). Of those 567, 69.5% reported chest discomfort, 59.6% chest pain and 53.4% shortness of breath, while fatigue, weakness or light-headedness and palpitations or a rapid heartbeat each came out at 45.9%.⁠⁴

So a chest complaint can be real while the large coronary arteries are open. If a fast heartbeat is part of your picture, start by reading what a normal heart rate is.

What a Dutch registry shows

A Dutch registry of 5,023 patients admitted with an acute coronary syndrome between 2015 and 2019 counted 1,463 women (29%), admitted at an average age of 69.7 ± 12.4 years against 65.5 ± 11.7 years for the men; over 36 months the women received less care in line with the guideline, while the adjusted outcomes were comparable.⁠⁵ That difference of about four years is worth knowing.

Blood pressure, salt and exercise

A pooled analysis of 27,542 adults from four population cohorts, followed for 28 ± 12 years, found that the risk in the women began to rise from a systolic blood pressure of 100 to 109 mm Hg and in the men from 130 to 139 mm Hg; women at 110 to 119 mm Hg carried a risk of a heart attack comparable to that of men at 160 mm Hg or higher.⁠⁶ So a value that looks ordinary on a general table can already sit in the rising part in women. De Gezondheidsraad advises no more than 6 grams of salt a day, while Dutch adults take in about 7 grams or more.⁠⁷

Exercise shows the same pattern. Among 412,413 American adults followed from 1997 to 2019, regular exercise in leisure time compared with no exercise was linked to a 24% lower death rate from all causes in the women (HR 0.76) and a 15% lower death rate in the men (HR 0.85); the women reached the same survival benefit at 140 minutes of moderate to intensive exercise a week as the men did at 300 minutes.⁠⁸ In the Netherlands in 2025, 46.1% of adults met the physical activity guidelines, and more men than women met them.⁠⁹ In practice that is a good two hours a week.

When to contact a doctor

Call 112 if you have pain or a heavy pressing feeling in your chest that stays when you sit down, with sweating, nausea, pain in an arm, the neck or the jaw, difficulty breathing or dizziness. Call your GP or the out of hours GP service straight away if you have sharp chest pain with breathing that is difficult and painful, or if your heartbeat is irregular and very fast while you are sitting quietly, and the same day if pressure or pain in your chest comes with a fever. On working days, make a normal appointment if chest pain keeps coming back and the cause is unknown.⁠¹⁰

In summary

Chest pain is the most reported complaint in both sexes, and the differences lie in what comes with it: pain in the back, the neck and the jaw, nausea, shortness of breath. The weeks before an acute heart problem carried fatigue and broken sleep more often than chest discomfort. A complaint can be real while the large coronary arteries are open, and blood pressure and movement carry different limits for women than for men. Thuisarts gives the signals that mean calling today, and the scan gives you a baseline. It is not a diagnosis.