Why Does Heart Disease Go Undiagnosed in Women?

More women die of heart disease each year than from all cancers combined — heart disease, stroke, and hypertensive disease, added together. It's the leading cause of death for women in the United States, even though it still gets framed as a man's disease.

September Dahlia

Part of the problem is how women read internal pain. Most women have lived through menstrual cramps, sometimes labor, which builds a frame of reference that tells them internal pain is often normal and passes. A heart symptom can get filed into that same category instead of registering as urgent.

The symptoms themselves often don't match the textbook chest-clutching picture:

• ‍Back, jaw, or epigastric pain that can feel like indigestion or strain

• ‍Palpitations, nausea, or suddenly not being able to catch your breath

• Fatigue and lightheadedness that show up out of nowhere

Women are also more likely to have nonobstructive or microvascular coronary disease, narrowing spread through the smaller vessels, not one blocked point a standard stress test or angiogram is built to find. A normal test doesn't rule out a real problem.

If you notice new back, jaw, or epigastric pain, breathlessness, or fatigue with no clear explanation, describe it plainly to your provider instead of waiting for classic chest pain. If a standard workup comes back normal and symptoms persist, ask about nonobstructive or microvascular disease specifically.

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