Here's what experts want you to know about the sneaky signs that your heart health isn't in great shape.
Lisa Marie Presley's recent fatal cardiac arrest felt shocking and sudden—she was only 54. But Presley isn't the only celeb to call attention to heart issues in women in recent years. Back in 2012, Rosie O'Donnell had a heart attack shortly after her 50th birthday, and in a TikTok video this week, she shared the top symptoms she experienced, which might not be obvious heart attack signs. "Hot, exhausted, pain, pale, puke," she said, noting that those are the words she uses to remember them.
"We should be informed about the risk factors, signs and symptoms for cardiac disease," says Dr. Deirdre Mattina, MD, a Cleveland Clinic cardiologist.
Heart disease is the leading cause of death among women and killed more than 314,000 women in 2020, according to the CDC. A 2020 report in Circulation found that women are more likely to die from a heart attack or heart failure than men.
"Women often ignore symptoms of heart disease, which was historically felt to be a 'man's disease'—this is far from the truth," says Dr. Briana Costello, MD, a general and interventional cardiologist at The Texas Heart Institute’s Center for Women’s Heart & Vascular Health.
With that in mind, here's what cardiologists want women to know, including symptoms of poor heart health they shouldn't ignore.
Why Heart Disease Is a "Silent" Issue in Women
Though awareness of heart disease in women has increased, it's still sometimes referred to as a "silent" condition. And frustratingly, there's been a lack of gender-specific studies on risk factors for heart disease in women, researchers pointed out in 2017.
But other issues may be at play."While we think sometimes heart disease can present differently between men and women, people are different and may describe pain and discomfort differently and may not recognize some of these symptoms related to the heart," says Dr. Mattina.
Biology and physiology complicate this issue, she says. "The heart doesn’t work in isolation. It’s connected to other major organs. Our heart pumps directly from our lungs and feeds into our vascular system."
So, many women may link "shortness of breath" to respiratory or lung issues rather than heart—but this red flag is one of many often-ignored symptoms of cardiovascular problems in women. Here are the other ones to keep in mind.
Top Signs of Poor Cardiovascular Health in Women
Dr. Mattina says it's important to be aware of some of the lesser-known signs of cardiovascular issues in women. One of the most important things to look out for: a change. "If there is a symptom that is new and has changed in frequency, intensity or duration, that’s probably something that needs to be checked out," Mattina says.
Mattina says women may shrug off fatigue, particularly if they're busy, burned out and caring for a family. "Women are always running around," Dr. Mattina says. "They control the care for so much of the rest of the household, so they focus less on their health."
However, fatigue could be one of the first signs of heart issues in women. "It could be that they are not getting enough blood flow to the heart arteries or the heart is not squeezing appropriately," Dr. Mattina says.
What does "fatigue" mean, especially if tired is your normal (because...life)? It's all about your baseline, so look out for a change.
"If you used to feel well-rested and there’s not an acute reason like you’ve pulled some all-nighters, those are the things you’d want to talk to with your provider,” says Dr. Mattina.
2. Shortness of breath
Exercise tolerance is a good barometer to help you measure shortness of breath. For example, Dr. Mattina says you may think, I was able to mall walk every day with my friends, and now I am having to stop, sit and rest.
"Those would be things we would look into a change in the heart function," Dr. Mattina says.
3. Leg swelling
Unexplained leg swelling can be a sign of venous insufficiency.
"[This] means the blood can’t pump up to our heart quick enough," Dr. Mattina says. "That can also be seen when the heart is not squeezing appropriately with a form of heart failure, and so we would begin a work-up if that was new or progressive in a patient.”
4. Pain in the chest area that can be mistaken for heartburn
The stomach and heart sit close to one another, so people can confuse typical indigestion with something more severe called angina, which Dr. Mattina says is pain from decreased blood flow to the heart. If taco night was never an issue for you and suddenly is, take note.
"If you are a person that ate tacos your entire life and never had indigestion and all of a sudden have it every day for a week, that could be something considered unusual and that you want to investigate," Dr. Mattina says.
5. Dizziness and palpitations
If your heart is beating fast at rest and you're feeling dizzy or nauseous, don't try to power through. "That could point us to a rhythm disorder if you are feeling your heart racing," Dr. Mattina says.
6. Jaw or back pain
Dr. Bobbi Chapman, MD, a cardiologist and the medical director of heart failure at Abiomed says pain in these areas is easy to overlook but may be the only symptom of a heart attack in women. Unexplained pain on the left side is particularly troubling. The American Heart Association also lists this symptom as one that women should keep in mind.
Snoring is more than an annoying issue for your bed partner. It could be a red flag of potential heart problems. "Snoring is often a sign of sleep apnea which leads to a multitude of changes in the body that can affect the heart," Costello says.
The CDC also lists sleep apnea as a condition that increases the risk of heart failure and disease.
How Women Can Protect Themselves From the 'Silent Killer'
Women can take steps to reduce their risk of heart disease or a fatal cardiac event.
First, Mattina recommends seeing a primary care physician. Many women focus on OB-GYN care during their child-bearing years but may overlook their annual physicals.
“It’s very important for women to see a primary care physician regularly," Dr. Mattina says. “It’s important to start early for prevention of heart disease.”
The doctor can assess blood pressure, cholesterol and glucose. If any of these are out of range, it can be a flag that a woman is more at-risk for heart disease. Sometimes, these conditions can be managed with diet and exercise.
“Women, especially in America, struggle with maintaining a healthy diet and exercise routine," Mattina says. "We are built as a nation to sit in front of devices and not be active a lot. It can be challenging for people that work or who are so focused on family.”
The American Heart Association recommends 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity physical activity per week.
Other times, medications, such as beta-blockers for high blood pressure, may be necessary. Sometimes, unfortunately, tragedies happen and women have a cardiac event that takes them and those who love them by surprise.
"All we can do is the best we can to minimize our risk factors," Dr. Mattina says.
Dr. Briana Costello, MD, a general and interventional cardiologist at The Texas Heart Institute’s Center for Women’s Heart & Vascular Health.