New heart attack guidance better reflects women’s experiences

A New Definition of Heart Attack Could Change Care for Women

A New Definition of Heart Attack Could Change Care for Women

By Kylie Long
Scientifically reviewed by: Michael A. Smith, MD

At a Glance

  • Heart attack signs in women can be different than in men—resulting in treatment disparities.
  • A new global definition of heart attack includes clearer, sex-specific diagnostic criteria.
  • The new guidance aims to improve heart attack diagnosis and treatment, particularly for women.

Talk about a change of heart! The European Society of Cardiology Congress in Munich announced a new definition of heart attack with clearer, sex-specific diagnostic criteria that experts hope will help women—whose symptoms can be different from their male counterparts—be diagnosed and treated correctly.

Endorsed by the world's four leading cardiovascular health groups, this guidance gives health professionals a new framework for treating patients with suspected heart attacks, putting more emphasis on imaging. Equally important, it elevates the priority of the less-common heart attack forms that are more prevalent in women.

One thing hasn't changed: the broad definition of a heart attack. Described medically as a myocardial infarction (MI), this term still refers to a reduction in blood flow to the heart muscle. Without timely restoration of blood flow and heart function, a heart attack can mean death.

What's new is the way this potentially fatal blockage is categorized and what goes into MI diagnosis. Some of the MI types that had been grouped with other, unrelated conditions are now considered primary, a classification that is expected to improve early diagnosis and health outcomes.

Let's dive into how heart attacks differ between men and women and why the definition has been revised.

Advanced Oxidized LDL Panel Combo Test

What are symptoms of a heart attack in women?

When you think of a heart attack, you may picture the classic chest-clutching scene of a man in distress. And it's true: Chest pain is the most common symptom of a heart attack in both men and women.

However, women tend to experience other, subtler symptoms more often than men, including pain in one or both arms, between the shoulder blades, or in the neck, jaw or abdomen. Some women also have upper back discomfort.

Making diagnosis even more complicated, many women experience symptoms that are associated with psychological distress, including:

  • Shortness of breath
  • Cold sweats
  • Nausea
  • Irregular heartbeat
  • Lightheadedness or feeling faint
  • Anxiety (sometimes described as a sense of "impending doom")
  • Unusual fatigue or weakness

Yes, these symptoms can be a sign of a panic attack, but they also can be a sign of a heart attack. It's important to note that men can experience these symptoms as well, so anyone, regardless of gender, who is experiencing these symptoms should be evaluated immediately.

Do men and women have the same heart attack risk factors?

Men and women share many risk factors for heart attacks, from high LDL cholesterol to low physical activity. However, women may face sex-specific risk factors that don't always fit the traditional picture of heart disease. Women who have experienced early menopause, pregnancy-related high blood pressure, gestational diabetes, and certain inflammatory conditions may be at increased risk, regardless of their arterial plaque status.

Additionally, a 2025 review links menopause to both cardiovascular risk factors and cardiovascular events, such as heart attack or stroke. While evidence suggests that declining estrogen may play a role, it is only one factor.

The bottom line: Menopause is a good time to take a closer look at your heart health. Talk with your doctor about your risk factors, review key labs, like cholesterol and blood sugar, and stay on top of preventive screenings.

Why is heart attack care different in men vs. women?

From the way a heart attack feels to the risk factors, disparities between the sexes abound. This may contribute to the difference seen in the quality of medical care. A 2024 systematic review of gender bias in cardiovascular care found that women were more likely to have their symptoms misdiagnosed as gastrointestinal or anxiety-related symptoms. Similarly, milder symptoms in women were often overlooked, especially by male physicians.

As a result, women received fewer diagnostic tests and appropriate referrals and, when hospitalized, were less likely to receive a coronary intervention.

According to a National Institutes of Health study, U.S. women under the age of 55 hospitalized for heart attacks had twice the risk of in-hospital death from an MI when compared with similarly aged men. With little difference in treatment, what shapes these statistics? Research suggests that this disparity may start in the waiting room because of a mix of gender bias and milder or misdiagnosed symptoms.

What has changed in the universal definition of a heart attack?

Previously, clinicians grouped heart attacks into five numbered types. The new universal definition simplifies this framework into three categories based on how they present in a clinical setting. Let's look at what these categories include, and how they may shape care in the hospital room:

1. Primary MI

Under the previous definition, Type 1 MI referred to atherothrombosis—a blood clot that forms after plaque in a coronary artery breaks open. The new "primary MI" category includes this type of heart attack, along with other acute coronary artery problems that block blood flow to the heart.

2. Secondary MI

The name tells you what sets it apart: a secondary myocardial infarction is a heart attack caused by another condition that strains the heart's blood supply. Think of a secondary MI as a supply and demand problem, in which acute illness creates a mismatch between the heart's oxygen supply and its oxygen demands (known as ischemia), resulting in a heart attack. Causes may include very high or very low blood pressure, a very fast heart rhythm, severe anemia, breathing failure or sepsis. The definition also includes a new area of heart muscle that isn't moving normally or has been damaged because another condition has reduced its blood—and oxygen—supply.

3. Procedure-related MI

A procedure-related MI refers to any cardiac complication within the first 30 days following a procedure that causes acute myocardial injury, along with at least one additional sign of a heart attack. When the complication occurs during the procedure or alongside an acute heart attack, both signs must be present for it to meet the definition of a procedure-related MI.

What Is a SCAD Heart Attack and Why Does It Mainly Affect Women?

SCAD stands for spontaneous coronary artery dissection, an uncommon cause of heart attack known to disproportionately affect women. It was previously categorized as a type 2 MI, but under the new definitions, it is now classified as a primary MI. With SCAD, a tear forms in the wall of a coronary artery, one of the blood vessels that keeps your heart supplied with oxygen-rich blood. This tear can restrict or block blood flow to the heart, leading to a heart attack.

Unlike atherothrombosis, the most common cause of heart attack in both men and women, SCAD can occur with little to no plaque buildup. That said, SCAD may not present the usual signs of atherosclerosis. It can even affect young, physically fit people, making it an exception to the usual heart attack risk profile.

SCAD is relatively rare, but when it occurs, it overwhelmingly affects women, who make up an estimated 80% to 90% of SCAD cases. Of these patients, many are postpartum or postmenopausal women without other risk factors for heart attack.

Hormones may play a role in SCAD, but researchers still have much to learn about what drives it. Until then, awareness, advocacy and continued research remain essential to bringing more attention to this lesser-known cause of heart attack.

Heart Attack Definitions: Then & Now

Before Now Why it matters
Type 1: A heart attack caused by atherosclerotic plaque disruption and blood clot formation (atherothrombosis) Primary MI: A heart attack caused by atherothrombosis, SCAD, coronary spasm, or coronary embolism (includes restenosis, stent thrombosis, or bypass graft failure occurring more than 30 days after a procedure)
  • Includes all acute coronary causes, helps place these events on the same diagnostic level as plaque-related MI
  • Gives greater recognition to causes that are particularly important in women
Type 2: A heart attack caused by imbalanced cardiac oxygen supply and demand, without acute atherothrombosis (included SCAD, coronary spasm, and coronary embolism) Secondary MI: A heart attack caused by another acute medical condition that produces imbalanced cardiac oxygen supply and demand (no longer includes SCAD, coronary spasm, and coronary embolism)
  • Old classification was broad and clinically mixed
  • Removes acute coronary artery problems from this category
Type 3: Death due to suspected heart attack before diagnostic testing was conducted Removed from classification
  • Limited use in clinical practice
  • Clinical classification (primary, secondary, or procedure-related) should be applied instead
Types 4 and 5: Heart attacks caused by various procedures; typically occur within 48 hours of the procedure Procedure-related MI: A heart attack caused by complication of cardiac procedure within 30 days
  • Combines former categories into one clinically focused category

How does the new heart attack definition benefit women?

Heart disease remains the leading cause of death in women in the United States. The new heart attack definition takes an important step toward recognizing that for these women, heart attacks don't always look the same.

When physicians describe a typical heart attack, the symptoms and pathology closely align with those of a typical heart attack in a man. And while these are often similar in women and men, women are more likely than men to present with less common mechanisms, including SCAD, coronary artery spasm and coronary embolism. The new definition groups these causes alongside plaque-related heart attacks as a primary myocardial infarction, reinforcing that women can have a heart attack without the usual cardiovascular risk profile.

The new definitions also reinforce the use of sex-specific thresholds for cardiac troponin, a key blood test used to detect heart muscle injury. Women generally have lower troponin values than men, so a single cut-off value for everyone can miss smaller but important rises in women. This change was made to avoid systematic bias and under-recognition in female patients.

You may be tough as nails, but that doesn't mean you should tough out unusual symptoms. Remember the signs, stay attuned to your body and pay attention to changes in how you feel.

If you experience any of these warning signs and think you may be having a heart attack, call 911 immediately. Get to an emergency room as soon as possible; even minutes can make a difference.

Key Takeaways

  • Heart attack signs in women may include discomfort in the chest, arms, upper back, the neck, jaw or abdomen.
  • Women are more likely to have heart attack symptoms mistaken for gastrointestinal issues or anxiety.
  • Be your own advocate. Ask questions and speak up about new or unusual symptoms.

References

About Our Story Sources

The Life Extension Health News team delivers accurate information about vitamins, nutrition and aging. Our stories rely on multiple, authoritative sources and experts. We keep our content accurate and trustworthy, by submitting it to a medical reviewer.

General Health & Wellness

Healthy Starts Here

Read More