Heart Health in Women: The Symptoms Doctors Often Miss

Written by Kristy Beard, MSN, APRN, FNP-C — Board-Certified Family Nurse Practitioner and Founder of Elevate Health and Wellness, serving patients across the Gulf Coast in Gautier, MS and Foley, AL.

Heart Disease: The Number One Killer of Women

Heart disease kills more women in the United States than all forms of cancer combined — yet it remains dramatically underrecognized as a women's health issue. According to the American Heart Association, approximately 1 in 3 women dies from cardiovascular disease, compared to 1 in 30 who dies from breast cancer. Despite these statistics, cardiovascular disease in women is less likely to be diagnosed, less likely to receive aggressive treatment, and more likely to be attributed to anxiety or non-cardiac causes during initial evaluation than the same presentation in men. On the Gulf Coast, where cardiovascular risk factors including obesity, hypertension, diabetes, and smoking are highly prevalent in both sexes, this diagnostic gap has serious consequences for Gulf Coast women.

How Women's Heart Disease Symptoms Differ

The classic presentation of a heart attack — crushing substernal chest pain radiating to the left arm — is actually more typical of men than women. Women experiencing acute coronary syndrome frequently present with atypical symptoms that are more easily attributed to gastrointestinal illness, anxiety, or musculoskeletal pain. These include unusual fatigue — often described as the most exhausting fatigue of their life — that may begin days to weeks before a cardiac event; shortness of breath without chest pain; nausea, vomiting, or indigestion; upper back, jaw, or neck pain; lightheadedness or dizziness; and chest discomfort that may be described as pressure, squeezing, or burning rather than sharp pain. Research published in JAMA found that women under 55 having a heart attack are more than seven times more likely than men to be sent home from the emergency department without being admitted — highlighting the diagnostic gap that atypical presentations create.

Unique Cardiovascular Risk Factors in Women

In addition to traditional risk factors shared with men, women have several sex-specific cardiovascular risk factors that deserve clinical attention. Pregnancy complications including preeclampsia, gestational hypertension, gestational diabetes, and preterm birth are now recognized as independent risk factors for future cardiovascular disease. Premature menopause before age 40 is associated with significantly elevated cardiovascular risk compared to natural menopause. Polycystic ovary syndrome (PCOS) carries elevated metabolic and cardiovascular risk due to insulin resistance and androgen excess. Autoimmune conditions including lupus and rheumatoid arthritis — which affect women disproportionately — increase cardiovascular risk through chronic systemic inflammation.

How Elevate Addresses Cardiovascular Health in Women

At Elevate Health and Wellness, Kristy Beard, MSN, APRN, FNP-C takes a proactive approach to cardiovascular risk in female patients that includes assessment of both traditional and sex-specific risk factors, comprehensive lipid evaluation including advanced markers, blood pressure monitoring, metabolic assessment for insulin resistance and glucose dysregulation, inflammatory marker evaluation, and — for women with multiple risk factors — consideration of carotid and vascular screening ultrasound. Hormone optimization during perimenopause and menopause, when clinically appropriate, is also considered in the context of cardiovascular risk given the cardioprotective effects of estrogen during the early menopause window.

Want a comprehensive cardiovascular evaluation tailored to women's health? Visit our Women's Health and Lab pages at Elevate in Gautier, MS and Foley, AL.

Sources: American Heart Association. Heart Disease in Women. heart.org. | JAMA. Sex Differences in Acute MI Presentation. jamanetwork.com.

This article is written by Kristy Beard, MSN, APRN, FNP-C, board-certified Family Nurse Practitioner and founder of Elevate Health and Wellness. Information provided is for educational purposes only and does not constitute medical advice. Please consult a licensed healthcare provider for personalized care.