Heart Disease Symptoms in Women: The Early Warning Signs Often Missed

Heart disease symptoms in women often look very different from those in men, and this difference is one of the major reasons heart disease remains the leading cause of death in women. Unlike the dramatic chest pain many people expect, the early signs of heart disease in women are usually subtle, easily dismissed, or attributed to stress, hormones, anxiety, or fatigue.

Many women never experience sharp chest pain at all. Instead, they report vague symptoms—shortness of breath, unusual tiredness, jaw or back pain, digestive discomfort, or lightheadedness—that do not immediately suggest a cardiac issue. Because these early warning signs are frequently overlooked or misdiagnosed, women often do not receive critical evaluation or treatment until heart disease has already progressed.

Women themselves may dismiss their symptoms, and healthcare providers may also underestimate them, leading to delays in diagnosis. This pattern of misinterpretation is one of the key reasons women have worse outcomes from heart disease, even though symptoms often appear earlier.

Recognizing the most common—and most easily overlooked—heart disease symptoms in women is essential for early detection, timely intervention, and long-term cardiovascular health.

Heart disease remains the number one cause of death in women, responsible for more than one in five female deaths every year. Yet the signs and symptoms women experience are frequently dismissed or misinterpreted—by both patients and clinicians.

Unlike men, women often present with atypical or “silent” heart attacks that do not resemble classic chest pressure. These sex-specific differences are not widely understood, which contributes to ongoing gaps in diagnosis and treatment.

This guide outlines the most common heart disease symptoms in women, the early signs of heart disease in women that often go unnoticed, why women’s symptoms differ from men’s, and how specialized lab testing can reveal cardiovascular risk well before symptoms appear.

Read: Women’s Heart Disease – Why Guidelines Still Fail → Women’s Heart Disease: Why Guidelines Still Fail – Even when women have risk factors and symptoms, they’re often underdiagnosed. Explore how male-centered heart guidelines, outdated biomarker cutoffs, and overlooked female risk factors contribute to missed heart disease in women—and how advanced lab panels can change that.

Why Heart Disease Symptoms in Women Are Different

Women’s cardiovascular systems differ from men’s due to biological, anatomical, and hormonal factors. These differences dramatically influence how symptoms appear and how heart disease develops.

How female biology affects symptom patterns

• Women have smaller coronary arteries, increasing the likelihood of microvascular dysfunction.
• Plaque buildup is often diffuse and soft, not the calcified blockages more common in men.
• Women's autonomic responses to stress and inflammation are different, affecting how symptoms manifest.

Hormonal influences on early symptoms

Estrogen provides vascular protection until menopause. As estrogen levels drop, women face increased inflammation, stiffer arteries, and accelerated risk.

Hormonal fluctuations during perimenopause also amplify early symptoms of heart disease and often mimic anxiety, gastrointestinal issues, or fatigue.

Most Common Heart Disease Symptoms in Women

Many women experience symptoms that are non-specific, subtle, or easily mistaken for other conditions.

Chest discomfort women often overlook

Women frequently describe chest sensations as pressure, tightness, heaviness, or burning—not sharp pain.

Shortness of breath and unusual fatigue

Breathing difficulty or extreme tiredness, even during light activity, is one of the most common early signs of heart disease in women.

Jaw, neck, back, or shoulder pain

Referred pain is more common in women than in men and is often misattributed to musculoskeletal issues.

Digestive symptoms mistaken for indigestion

Nausea, abdominal discomfort, and indigestion-like symptoms are frequently reported by women during cardiac events.

Lightheadedness, dizziness, or faintness

Women may experience nearly passing out or sudden weakness during cardiac distress.

Sweating or sudden clamminess

Cold sweats—even without exertion—may signal a cardiac event.

Early Signs of Heart Disease in Women

Early symptoms often begin weeks or months before a major cardiac event, but they are easy to overlook.

Subtle symptoms that appear before a heart attack

• Sudden or extreme fatigue
• Shortness of breath during simple tasks
• Sleep disturbances or waking up short of breath
• Anxiety or unexplained sense of dread
• Persistent mild chest discomfort

Pain patterns unique to women

Women may feel discomfort in both arms, the jaw, shoulders, or upper back—none of which immediately suggest “heart attack” to most people.

Silent Heart Attack Symptoms in Women

A silent heart attack presents with no classic chest pain. Women may experience:

• Sudden fatigue
• Shortness of breath
• Indigestion-like discomfort
• Jaw or back pain
• Lightheadedness

Nearly half of women who have silent heart attacks do not realize it until their doctor identifies evidence of heart damage.

Why Women’s Symptoms Are Misdiagnosed

Bias in diagnostic guidelines

Most heart disease research historically focused on men, leading to diagnostic tools that overlook female-specific patterns.

Microvascular disease often goes undetected

Traditional stress tests and angiograms may appear normal even when women have serious microvascular dysfunction.

Women often minimize or reinterpret their symptoms

Busy schedules, caregiving roles, and chronic stress contribute to women ignoring early cardiac warning signs.

Hormonal symptoms overlap with cardiac symptoms

Perimenopause, anxiety, and thyroid shifts can mask early signs of heart disease in women.

Who Is at Higher Risk for Heart Disease Symptoms?

Women with the following factors should pay close attention to symptoms:

• Family history of heart disease or early heart attack
• High blood pressure or high cholesterol
• Diabetes, insulin resistance, or metabolic syndrome
• History of preeclampsia, gestational diabetes, or pregnancy-induced hypertension
• Autoimmune diseases such as lupus or rheumatoid arthritis
• PCOS or hormonal disorders
• Early or surgical menopause

Heart Disease Symptoms in Women: Early Warning Signs Most Doctors Miss → This companion article pairs with the guideline discussion to give you a complete picture of how heart disease develops, presents, and often hides in women.

When Women Should Seek Medical Attention

Women should seek immediate care if they experience:

• Chest pressure, tightness, or fullness lasting more than a few minutes
• Shortness of breath with or without chest discomfort
• Jaw, neck, shoulder, or upper back pain
• Nausea, vomiting, or sudden cold sweating
• Severe fatigue or dizziness

How Lab Testing Helps Detect Heart Disease Early

Symptoms are often late-stage signals of cardiovascular disease. By the time noticeable symptoms appear, underlying inflammation, microvascular dysfunction, metabolic impairment, or plaque instability may already be present. This is especially concerning for women, whose heart disease symptoms are frequently subtle, atypical, or easily mistaken for stress, fatigue, indigestion, or hormonal changes.

Lab testing can detect risk years before symptoms appear, giving women and clinicians the opportunity to intervene early. Many of the most overlooked symptoms—such as fatigue, shortness of breath, jaw or back pain, digestive discomfort, or dizziness—are directly linked to changes in measurable biomarkers.

The Most Overlooked Heart Disease Symptoms in Women — and the Lab Tests That Help Explain Them

1. Unexplained Fatigue

Persistent or unusual tiredness may reflect anemia, thyroid dysfunction, inflammation, or early cardiac strain.

Helpful lab tests: CBC, Ferritin, Thyroid Panel, hs-CRP, Fasting Insulin, HOMA-IR

2. Shortness of Breath During Light Activity

Breathing difficulty with minimal exertion can signal early cardiac dysfunction.

Helpful lab tests: NT-proBNP, Cystatin-C with eGFR, CMP

3. Jaw, Neck, Shoulder, or Back Pain

Women often experience cardiac pain in non-chest locations.

Helpful lab tests: hs-CRP, Lp-PLA2, MPO, ApoB, Lipoprotein(a)

4. Nausea, Indigestion, or Stomach Pain

Commonly mistaken for gastrointestinal issues, these can be cardiac in origin.

Helpful lab tests: Oxidized LDL, ApoB, LDL-P, Full Lipid Panel

5. Dizziness or Lightheadedness

May indicate rhythm disturbances, low cardiac output, or hormonal imbalance.

Helpful lab tests: NT-proBNP, CMP, Thyroid Panel

6. Pain in One or Both Arms

Women may feel discomfort in either arm due to referred cardiac pain.

Helpful lab tests: hs-CRP, NMR Lipoprotein Profile, Galectin-3

7. Cold Sweats or Sudden Clamminess

Cold sweating may reflect acute cardiac stress.

Helpful lab tests: hs-CRP, MPO, Lp-PLA2

8. Chest Pressure Instead of Chest Pain

Women often report heaviness, tightness, or burning rather than sharp pain.

Helpful lab tests: High-sensitivity Troponin, ApoB, Lipoprotein(a), LDL-P

Key biomarkers for women’s heart disease detection

• Apolipoprotein B (ApoB) – reflects the total number of atherogenic particles.
• Lipoprotein(a) – a genetically driven, lifelong risk factor that should be tested at least once.
• High-sensitivity CRP (hs-CRP) – marker of vascular inflammation.
• NMR Lipoprotein Profile – shows LDL particle number and size, including small dense LDL.
• Fasting insulin & HOMA-IR – identify insulin resistance before blood sugar rises.
• Cystatin-C – a more sensitive marker of kidney function and cardiorenal risk than creatinine alone.
• Galectin-3 – associated with fibrosis and heart failure risk.
• Lp-PLA2 and MPO – markers of vascular inflammation and plaque activity.
• Vitamin D & Ferritin – influence inflammation, energy, and overall cardiometabolic health.
• Thyroid and sex hormone panels – crucial for women in perimenopause, menopause, or with hormonal symptoms.

These sex-specific biomarkers reveal inflammation, microvascular dysfunction, metabolic disease, and lipid particle abnormalities—the root causes of heart disease in many women.

Ulta Lab Tests offers women-focused cardiometabolic panels designed to help identify risk long before symptoms escalate, empowering women and their clinicians to act earlier.

Bottom Line: Women’s Heart Disease Symptoms Are Different—and Must Be Taken Seriously

Women often experience subtle, confusing, or atypical symptoms that don’t resemble the stereotypical heart attack. This is why early detection—through symptoms, history, and sex-specific biomarkers—is critical.

Understanding how heart disease presents in women saves lives.

Testing early saves lives.

Listening to your body saves lives.

If you notice any concerning symptoms—or if you simply want to understand your heart risk better—talk with your healthcare provider and consider using women-specific heart and metabolic lab panels to get a clearer picture of your cardiovascular health.