Doctors and cardiology experts are highlighting that heart attacks in women can present with subtle and unusual signs that are often overlooked, such as fatigue and breathlessness rather than the classic crushing chest pain more commonly associated with heart attacks in men. A recent case shared by Dr. Obaidur Rahman, an orthopaedic and sports surgeon, describes one such example.
In an Instagram post shared by Dr. Rahman, he described the experience of a 36-year-old woman who had been feeling “extreme unexplained fatigue”, a tiredness far beyond ordinary tiredness, on the morning of the event. Her arms felt heavy and her body felt “wrong,” even early in the day. As the day progressed, she developed mild nausea and shallow breathing without intense pain. Eight hours after the onset of these symptoms, her heart stopped negotiating, she suffered an atypical myocardial ischaemia, commonly known as a heart attack.
The doctor noted there was “no fever,” “no stomach bug,” and no chest pain. Instead, early signs were subtle: fatigue, nausea and breathlessness, symptoms that many people, especially women, may dismiss as stress, acidity, lack of sleep or general fatigue. This presentation is sometimes referred to in cardiology as atypical myocardial ischemia, and it is more common in women than in men.
Medical research1 and clinical experience have found that women are more likely than men to have heart attacks without obvious chest pain. Instead, women may experience a range of atypical or non-classic symptoms, including:
Unusual or extreme fatigue
Shortness of breath
Nausea or indigestion-like sensations
Dizziness or lightheadedness
Pain or discomfort in the jaw, neck, back or arms
Cold sweats or clammy feeling
These symptoms can be subtle and easily attributed to non-cardiac causes, such as stress, acid reflux or lack of sleep, making early detection more challenging. For example, unusual fatigue often precedes heart attacks in women, as shown in multiple clinical observations, and may even occur days or weeks before the event.
Sometimes, a heart attack may occur with minimal or no noticeable symptoms at the time, a phenomenon referred to as a silent heart attack. According to health authorities and clinical data, silent heart attacks are more likely in women than men and may be discovered only later through diagnostic testing such as an electrocardiogram (ECG).
Health organizations also note that symptoms such as shortness of breath and nausea can occur without chest pain and should not be ignored, especially when appearing with sudden fatigue or an overall sense that something is “not right.”
While heart attacks are more commonly expected in older adults, women in their 30s and 40s can also be affected, especially if they have risk factors such as:
High stress or chronic fatigue
Smoking and sedentary lifestyle
Poor sleep and hormonal changes
Autoimmune conditions or pregnancy-related complications
Family history of heart disease
Certain conditions specific to women, such as hyper-coagulability (increased risk of blood clots), can further raise the likelihood of cardiac events, including heart attacks. Dr. Rahman and other physicians point out that this phenomenon may be more prominent in women taking oral contraceptives or with certain medical syndromes.
Heart attack symptoms vary, and the American Heart Association notes that women are more likely than men to report symptoms other than chest pain, such as shortness of breath, nausea or back and jaw discomfort. These signs may occur both with and without chest pain.
When heart muscle blood flow is blocked, even partially, the heart tissue can become injured, triggering symptoms that range from subtle malaise to more obvious discomfort. Silent heart attacks happen when such symptoms are faint or easily overlooked.
Doctors emphasise that any sudden, unexplained fatigue, especially when accompanied by nausea, breathlessness, discomfort in non-chest areas, or a persistent sense that something is wrong, should prompt medical evaluation. This is particularly important for women, who may not experience the textbook heart attack symptom of crushing chest pain. Early recognition and prompt care can be crucial in reducing damage and improving outcomes.
Reference
1. Coppell Emergency Room. “Silent Heart Attacks in Women.” CoppellEmergencyRoom.com. Accessed 1st January 2026. https://coppellemergencyroom.com/blog/silent-heart-attacks-in-women/.
Rh/TL)