Chest pain in Women: Symptoms, Causes, Complications and Treatment

Heart disease is the leading cause of death in women, yet many remain unaware of how differently chest pain manifests in women compared to men. Unlike the overwhelming chest pressure commonly experienced by men, women often face subtler, less recognisable symptoms of heart disease/acute coronary syndrome (Commonly known as an attack, minor or major).

Chest pain in women can present as dizziness, unusual fatigue, or nausea, making it easier to dismiss or misinterpret these warning signs. This comprehensive guide explores the unique characteristics of left-side chest pain in women, helping readers understand the symptoms, causes, and when to seek immediate medical attention. 

Symptoms of Acute Coronary Syndrome (ACS)

The primary symptoms of pain in the chest in women include:

• Chest Discomfort: Women commonly report squeezing and tightness in their chest.
• Upper Body Pain: Pain or discomfort spreads beyond the chest to multiple areas, including:
  • Neck and jaw
  • Both arms
  • Upper back
  • Upper stomach region

Women frequently experience accompanying symptoms that might seem unrelated to chest pain. These include:

• Physical Symptoms:
  • Shortness of breath
  • Unusual fatigue
  • Sweating or cold sweats
  • Lightheadedness
  • Nausea or vomiting
  • Heart palpitations
• Timing and Duration: The pain patterns in women show distinct characteristics. They tend to experience these symptoms more often during rest or sleep. The sensations might last several minutes, disappear, and then return.
• Anxiety-related Symptoms: Studies indicate that women report specific anxiety-related symptoms alongside chest pain, including:
  • Heart flutter
  • Lightheadedness
  • Shortness of breath

Women often attribute their chest pain to non-cardiac causes, particularly acid reflux or anxiety. This misattribution and varied symptom presentation can lead to delayed diagnosis and treatment.

Non-ACS Causes of  chest pain in women

The underlying reasons of chest pain in women often differ from those in men, with several unique risk factors playing crucial roles. Studies reveal that women face distinct health challenges that increase their susceptibility to chest pain.

• Hormonal Influences: Menopause marks a significant turning point in women's heart health. The sharp drop in oestrogen levels after menopause increases the risk of small vessel heart disease. Therefore, post-menopausal women show impaired endothelial function, although oestrogen therapy can improve blood flow.
• Medical Conditions: Several health conditions specifically affect women's risk of experiencing chest pain:
  • Pregnancy-related issues: High blood pressure or diabetes during pregnancy significantly raises the long-term risk of cardiovascular problems
  • Autoimmune diseases: Conditions such as lupus and scleroderma occur more frequently in women, subsequently increasing heart disease risk
  • Diabetes: Women with diabetes face a higher likelihood of developing cardiac disease compared to men with the same condition
• Lifestyle and Behavioural Factors: Certain lifestyle choices pose greater risks for women:
  • Smoking: Research indicates smoking presents a more substantial risk factor for heart disease in women versus men
  • Physical inactivity: Lack of regular exercise emerges as a significant risk factor
  • Emotional health: Stress and depression affect women's hearts more severely than men's, often making it challenging to maintain healthy lifestyle habits
• Other Contributing Factors: Medical research has identified additional causes specific to women:
  • Insulin Resistance: This condition shows a strong association with endothelial dysfunction and microvascular angina
  • Inflammation: Elevated C-reactive protein levels correlate with symptom activity and myocardial ischaemia in patients with normal coronary angiograms
  • Family History: Early heart disease in the family appears to pose a greater risk factor for women compared to men

Complications of Chest Pain in Women

Women face unique cardiovascular challenges, including:

• Small Vessel Disease: Women tend to develop blockages not only in main arteries but also in smaller vessels supplying blood to the heart, a condition known as coronary microvascular disease
• Nonobstructive Disease: Females more commonly experience heart attacks without severe arterial blockage, termed nonobstructive coronary artery disease
• Late-onset Symptoms: Females typically develop cardiovascular disease symptoms approximately 10 years later than males

Research indicates that women with heart failure exhibit distinct complications:

• Higher instances of shortness of breath during physical activity
• Greater difficulty with exercise
• Increased likelihood of swelling (oedema)
• More frequent development of left bundle branch block

Diagnosis

The initial diagnostic process involves several key tests:

• Electrocardiogram (ECG): This quick assessment shows heart activity patterns, however, women might show normal ECG results even with underlying heart conditions
• Blood Tests: These measure specific heart proteins and cardiac troponin levels, though women tend to show lower troponin elevations compared to men
• Chest X-ray: This examination reveals lung conditions and heart size, helping eliminate non-cardiac causes
• Computerised Tomography (CT): This detailed imaging identifies blood clots and aortic issues
• Advanced Diagnostic Tools:
  • Echocardiogram: Sound waves create detailed heart images, showing blood flow patterns through heart valves
  • Stress Testing: This assessment evaluates heart function during exercise, offering crucial insights into coronary heart disease
  • Coronary Catheterisation: This procedure identifies arterial blockages, though women often show no significant obstructive coronary artery disease

Treatment

• Medication-based Treatments: Doctors often prescribe several types of medicines to manage chest pain effectively:
  • Nitrates: These medicines widen blood vessels, increasing blood flow to the heart muscle. Fast-acting nitroglycerin provides quick relief when taken as tablets under the tongue
  • Blood Pressure Medicines: These medications relax and widen blood arteries, making it easier for blood to circulate
  • Statins: These drugs prevent plaque formation and slow down coronary heart disease progression. They prove particularly effective in reducing blood vessel spasms
  • Blood-thinning Medications: Antiplatelet medicines and anticoagulants help prevent blood clots from forming, thereby decreasing future complications
• Surgical Interventions: For cases unresponsive to medication, doctors might recommend surgical procedures:
  • Angioplasty and Stent Placement: This procedure removes arterial blockages using a balloon-tipped catheter, often followed by stent placement to keep the artery open
  • Coronary Artery Bypass Surgery: Surgeons create new paths for blood circulation around blocked arteries using blood vessels from other body parts
  • Enhanced External Counterpulsation: This non-invasive treatment improves oxygen-rich blood flow to the heart muscle. 
• Lifestyle Modifications: Alongside medical treatments, doctors emphasise lifestyle changes:
  • Regular physical activity
  • Maintaining a healthy weight
  • Following a heart-healthy diet
  • Managing diabetes through regular checkups
• Specialised Treatments: There are for specific types of chest pain:
  • Acid-reducing medicines for heartburn-related pain
  • Anti-anxiety medications for panic-related chest pain
  • Transmyocardial laser treatment to stimulate new blood vessel growth

When to See a Doctor

Emergency Situations Call emergency services immediately upon experiencing:

• Chest pain lasting more than five minutes
• Pain that persists despite rest or medication
• Unexplained or sudden chest discomfort
• Pain accompanied by sweating, nausea, or vomiting
• Shortness of breath or light-headedness
• Irregular heartbeat
• Pain spreads to the back, jaw, neck, upper abdomen, arm, or shoulder.

Conclusion

Medical research clearly shows that women tend to experience subtler signs of heart problems, such as fatigue, nausea, or pain in multiple body areas. These symptoms, combined with hormonal influences and specific risk factors, make proper diagnosis particularly challenging for doctors.

Early recognition of warning signs saves lives. Women should pay attention to unusual symptoms, especially when these occur during rest or sleep. Though chest pain might seem mild or unrelated to heart problems, prompt medical attention proves essential for preventing serious complications.

FAQs

1. When should I be worried about chest pain for women?

Women should seek immediate medical attention if chest pain persists beyond five minutes or fails to subside with rest. Research indicates that 20% of women experiencing heart attacks do not feel chest pain at all. Watch for these warning signs:

• Discomfort spreading to both arms, back, or jaw
• Sudden onset of nausea or vomiting
• Unexplained fatigue or weakness
• Light-headedness or fainting
• Cold sweats
• Irregular heartbeat

2. Can lack of sleep cause chest pain?

Scientific studies confirm a direct link between sleep patterns and chest pain. Research reveals that both insufficient and excessive sleep increase the risk of chest pain. Sleep affects chest pain through several mechanisms:

• Poor sleep triggers surges in heart rate and blood pressure
• Sleep disruption heightens stress and anxiety levels
• Sleep deprivation increases sensitivity to pain
• Inadequate rest affects heart vessel repair
• Sleep issues worsen acid reflux symptoms

3. What are the bad signs of chest pain?

Certain chest pain symptoms warrant immediate emergency care. Medical data highlights these dangerous indicators:

• Pain lasting longer than five minutes without improvement
• Sudden onset of severe discomfort
• Pain accompanied by:
  • Breaking out in cold sweats
  • Shortness of breath
  • Light-headedness
  • Nausea or vomiting
  • Upper back pressure resembling rope tightness