Women’s heart health

Reviewed by our expert panel
Women’s heart health

Heart disease is a leading cause of death in New Zealand women, but most of us don’t know how to spot the symptoms. HFG explains what to look for.

Would you recognise the signs of a heart attack if you were having one?

What if we told you stereotypical heart-clutching chest pain isn’t the only way a heart attack feels or looks — especially in women? In fact, some women don’t even have chest pain at all.

Heart disease is the leading killer of New Zealand women, claiming nearly 60 lives every week. But if you know the warning signs of, or risk factors for, a heart attack, it could save your life.

One of women’s biggest foes

Heart attacks don’t just happen to stressed-out, middle-aged men with beer bellies. Women get them, too.

Like men, women can be diagnosed with a range of heart conditions that include angina, heart attack, heart failure and abnormal heart rhythms. Heart disease kills twice as many New Zealand women than any other single cause, but most women are not aware of this.

Despite these stats, there are fears women with heart disease are getting a raw deal. Across the Tasman it’s been found women with heart disease are often diagnosed later. New research has found Australian women who suffer a serious heart attack are half as likely to receive proper treatment in hospital as men, and twice as likely to die six months after they’re discharged.

Women are also less likely to be prescribed preventive medications, or to be referred to cardiac rehab for support.

Undertreatment for women was also found in a 2018 US study, and a 2016 study from the UK found women had a 50 per cent higher chance than men of getting a wrong initial diagnosis following a heart attack. Older research in New Zealand has also found treatment gaps in primary care for women with cardiovascular disease.
So, it’s more important than ever to know the warning signs and implement lifestyle changes that will stop heart disease progressing.

How women’s symptoms differ

Women may experience a range of symptoms that are related to heart attack, and many of these may not involve any chest pain. Instead, they may notice dizziness, breathlessness, palpitations and fatigue — symptoms that can be very non-specific and associated with other medical conditions. Because these symptoms can be vague, and women tend to be less likely to think heart disease is something relevant to them, they often delay seeking help.

As well as recognising symptoms, women can help prevent an attack by being aware of the risk factors. Most women aged 30–65 have at least one heart disease risk factor such as being overweight, a family history of premature ischaemic heart disease, high cholesterol, smoking, lack of exercise and stress.

When things go wrong

Women’s hearts are smaller and beat faster than men’s, and their blood vessels are smaller. While men typically experience narrowing in the heart’s main arterial highways, women often have blockages in the heart’s smaller laneways and crossways, a condition called microvascular disease (MVD).

These small blockages can go undetected in women for decades because they don’t readily show up in angiograms, which target arteries.

Potential symptoms of MVD in women include tiredness and chest pain brought on by cold weather, stress or exercise. These happen when tiny blood vessels either go into spasm or fail to widen, leading, in some cases, to cramping pain in the heart muscle, but sometimes no pain at all.

Spontaneous coronary artery dissection (SCAD) is another condition that mostly affects women. The symptoms are similar to those of heart attack or angina, but SCAD often affects women in their 40s or 50s, or who are very fit, or have just had a baby. SCAD is caused when a tear suddenly develops between the inner layers of a coronary artery. Blood flows into this space and reduces the blood flowing to the heart.

Recognising the warning signs of a heart attack, and getting treatment as quickly as possible, is important to reduce the damage caused.

Hidden heart attack triggers


People with depression are twice as likely to suffer from a heart attack. Why? Depression triggers inflammatory chemicals called cytokines that create inflammation, which can damage the lining of your heart’s blood vessel walls.

Look after your heart

Reach out to family members and your GP or a counsellor, for support and coping strategies.


Research shows that people exposed to noise pollution, such as traffic or flight path noise, have a high risk of heart failure, irregular heart rhythms, elevated blood pressure and high cholesterol.

Look after your heart

If you live on a busy road or in a noisy area, sound insulation and double glazing could be a life saver.


Exposure to pollution can accelerate plaque build-up in the heart, most likely due to inhaled particles entering the bloodstream and causing inflammation.

Look after your heart

Avoid exercising near busy main roads at peak hours when traffic pollution is heavy.


If a family member has had a heart attack, particularly between 55–65, you may have inherited heart disease risk.

Look after your heart

Check your family history (your brother, sister, parent or grandparent) to find out if you’re at higher risk, and make sure your GP is aware of any genetic conditions.


Social isolation or loneliness increase heart attack risk by 29 per cent, according to US research.

Look after your heart

Catch up with friends regularly, perhaps by going for a ‘walk and talk’ outdoors on the weekends or join a local yoga studio, cooking class or volunteer organisation.

Warning signs that could save your life

A heart attack doesn’t always manifest as chest pain. You could experience one or a combination of these signs.


A general discomfort in your neck, or a choking or burning feeling in your throat. This discomfort may spread from your chest or shoulders to your neck.


An ache or tightness in and around your lower jaw, on one or both sides.


A dull ache in between your shoulder blades, which can spread from your chest to your back.


A general ache, heaviness or pressure around one or both of your shoulders.


Pain, discomfort, heaviness or uselessness in one or both arms. This may also feel like numbness or tingling. This discomfort may spread from your chest to your arm(s).


Pain, heaviness, tightness, pressure or a crushing sensation in the centre of your chest. This discomfort may be mild and make you feel generally unwell.

You may also experience

  • Dizziness
  • A cold sweat
  • Nausea
  • Shortness of breath

10 steps to lower your heart attack risk

Step 1

Know your numbers

Do you know your cholesterol and blood pressure levels? Elevated levels of these are risk factors for heart disease. See your GP annually, and keep tabs on your numbers.

Step 2

If you’re overweight, lose just 5–10% of your weight

Two-thirds of adult New Zealanders are either overweight or obese — which increases the risk of developing heart disease up to three times. Your risk will also increase if you store fat around your tummy, which is more dangerous than fat on thighs and buttocks. But lose just 5—10 per cent of your body weight and your blood pressure and cholesterol falls.

Step 3

Try the acclaimed Mediterranean diet

A Mediterranean-style diet loaded with veges, fruit, nuts, legumes, oily fish and olive oil reduces the risk of heart disease by about 25 per cent.

Step 4

Check your stress

Too much stress has many detrimental effects on the body, and one of those is an increased risk of developing heart disease.

But some simple things help you manage it: practising yoga, listening to music, taking a walk, getting 7–8 hours sleep a night, and trying to laugh a bit more.
Laughing has been found to reduce stress and help your heart health. Studies have also shown frequent hugs can slow blood pressure as well as heart rate, reduce stress levels in women, and increase levels of the feel-good hormone, oxytocin.

First published: Sep 2019

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