Heart disease in women: symptoms to act on and prevention that has changed

The short answer: Chest discomfort is still the most common heart-attack symptom in women. Women may also have breathlessness, nausea, unusual fatigue, or pain in the jaw, back, shoulder, or arm. Do not wait for a dramatic collapse or assume that symptoms are anxiety or menopause. MC26

When to call 911

Call 911 for possible heart-attack symptoms, especially new chest pressure or discomfort with shortness of breath, sweating, faintness, or upper-body pain. Symptoms can come and go. Calling emergency services allows assessment and treatment to begin sooner than waiting for a clinic response. MC26

Stroke warning signs include sudden loss of balance, vision changes, facial drooping, arm weakness, or trouble speaking. Sudden severe headache or confusion can also matter. Call 911 even if the symptoms disappear. Note when the person was last known to be well. MC33

Your pregnancy history remains part of your heart history

Preeclampsia, pregnancy-related hypertension, gestational diabetes, and other adverse pregnancy outcomes can identify a higher need for long-term cardiovascular follow-up. The issue should not disappear from the record when postpartum visits end. Tell your primary-care clinician about these events even if the pregnancy was many years ago. MC30

Bring a discharge summary or write down what you remember. Ask that the pregnancy complication be included in future risk discussions. If you do not know the exact diagnosis, a records request can be more useful than guessing.

There is more than one kind of coronary disease

Many heart attacks involve plaque in a large coronary artery. But women can also have disease affecting the small vessels or problems with vessel relaxation. This can cause angina despite a test that does not show a major obstructive blockage. Selected patients may need additional imaging or specialized coronary testing. MC27 MC28

A reassuring test result is useful, but persistent or worsening symptoms still need a follow-up plan. Ask what the test answered, what it did not assess, and what to do if the symptoms return. Do not interpret “no large blockage” as a complete explanation for every ongoing chest symptom.

Spontaneous coronary artery dissection, or SCAD, is a tear within a coronary artery wall. Its management can differ from treatment for plaque-related heart attacks. Stable patients may be managed without a stent, while unstable situations can require intervention. The diagnosis and treatment require cardiology expertise. MC29

What has changed in prevention?

The 2026 ACC/AHA dyslipidemia guideline replaced the 2018 cholesterol guideline. It recommends measuring lipoprotein(a), often written Lp(a), at least once in adulthood, uses newer PREVENT-ASCVD risk equations, and includes selected use of ApoB testing and coronary calcium scoring to refine decisions. These tools support individualized care; they do not mean everyone needs a scan. MC32

The 2025 blood-pressure guideline emphasizes accurate measurement, home monitoring, and treatment based on both readings and overall risk. A common treatment goal is below 130/80 mm Hg, but pregnancy, frailty, limited life expectancy, and tolerability can require different decisions. A validated upper-arm cuff is preferable to assuming a watch gives reliable blood-pressure measurements. MC31

Discuss the complete pattern: smoking, diabetes, kidney disease, family history, blood pressure, cholesterol, pregnancy history, and symptoms. A high HDL result or a low short-term risk estimate does not answer every question about lifetime risk.

Medicines are chosen for the condition and the outcome

Treatment may involve blood-pressure and cholesterol medicines, anti-anginal treatment, rehabilitation, and management of diabetes or kidney disease. Some newer metabolic medicines have demonstrated cardiovascular or kidney benefits in defined patient groups. For example, empagliflozin has indications for adult heart failure and selected chronic kidney disease, and semaglutide has a cardiovascular-risk-reduction indication for certain adults with established cardiovascular disease and overweight or obesity. MC41 MC44

Those findings do not mean any patient with fatigue or weight gain should receive those drugs. Ask which diagnosis is being treated and which outcome the medicine is expected to improve. If a medicine is unaffordable, report that before repeatedly missing doses so the care team can discuss alternatives.

Aspirin and hormones are not universal prevention

Do not start daily aspirin simply because you are getting older. The USPSTF recommends against starting it for primary prevention at age 60 or older; decisions for selected younger adults depend on cardiovascular and bleeding risk. This differs from aspirin prescribed after certain cardiovascular events. Do not stop prescribed aspirin without discussing why it was prescribed. MC34

Menopause hormone therapy should not be started solely to prevent heart disease. Symptom treatment and cardiovascular prevention each need their own risk discussion. MC60

A prevention visit that produces an actionable plan

Bring home readings if you have them, a complete medication list, and any past test results. Ask the clinician to identify the most important next step rather than leave with an undifferentiated list. It might be confirming high blood pressure, restarting an affordable medicine, addressing tobacco use, or investigating exertional symptoms.

Questions to ask

• Do my symptoms need urgent testing or cardiology referral?
• Does my pregnancy or family history change my risk?
• Have I had an Lp(a) measurement, and would any other test change treatment?
• What blood-pressure and cholesterol goals fit my circumstances?
• If a prior test was reassuring, what is the follow-up plan for persistent symptoms?
• Would cardiac rehabilitation or a nutrition referral help?