Pain or tightness in your chest can be not only uncomfortable, but also unsettling. Especially when it comes seemingly out of nowhere and you're not sure of the cause. Many of us immediately begin to worry about our heart health. And while a heart attack can cause chest pain, there are many other less serious culprits, too. Here, doctors explain what causes chest pain in a woman and how to determine what's behind your discomfort.
What causes chest pain in a woman?
Buckle up, because this is a loaded question. Between hormonal fluctuations and a higher risk of cardiovascular events compared to men, there are a few common culprits that may be behind your chest pain.
Heart palpitations
Heart palpitations are actually a very common symptom in women who are going through perimenopause and menopause. This sensation of the heart beating hard or fast (or both) is often described as a mild ache or pain, explains Bruce Dorr, MD, FPMRS, FACOG, practitioner at the Littleton GYN & Wellness/Right Balance Hormone Health Center and senior medical advisor for Biote.
"It is almost never truly painful, but it can certainly be distressing," he says. "Palpitations can also be a result of estrogen excess or deficiency, related to thyroid problems, a result of metabolic concerns like diabetes or glucose problems, anxiety [such as a panic attack] or even cardiac problems."
Heart receptors are very sensitive, Dr. Dorr says, and often influenced by many aspects of the brain and hormone-producing organs.
Gastro-esophageal reflux disease (GERD)
GERD is a common, more severe case of acid reflux where acid from the stomach rises into the esophagus and causes pain, indigestion and heartburn. In some cases, this condition may cause the esophagus to spasm, which may cause sudden and severe type of chest pain, explains Bradley Serwer, MD, Interventional Cardiologist and Chief Medical Officer at VitalSolution, an Ingenovis Health company that offers cardiovascular and anesthesiology services to hospitals nationwide.
Angina
This is a condition related to the heart that is typically considered an early warning sign that you're at an increased risk of a heart attack, says Eduardo Sanchez, MD, FAAFP, Chief Medical Officer (CMO) for Prevention for the American Heart Association (AHA). It can feel like squeezing, burning, heaviness or pressure in your chest, he says. It can also cause shortness of breath or fatigue. Angina occurs because one or more coronary arteries are narrowed or blocked by plaque buildup.
While it can be a sign of an impending heart attack, there are a few types of angina women should be aware of. The most common is stable angina, Dr. Sanchez explains, which usually occurs during physical strenuous activity or emotional distress. Unstable angina occurs in the absence of physical activity, and this is the more serious variation that could be a warning of an attack.
Stress-induced cardiomyopathy
Also known as Takotsubo cardiomyopathy, this is a condition where there is a sudden, temporary weakening of the heart muscle, explains Dr. Serwer. It is often referred to as "broken heart syndrome" and is commonly seen after someone is exposed to psychological or physical shock. This may present as shortness of breath or chest pain in women, and it often mimics a heart attack, he adds. The difference? There is no disruption of blood flow to the heart muscle, and a majority of the time, the heart function returns to normal.
Stress cardiomyopathy is most common in postmenopausal women. This is because after menopause, you have an increased sympathetic nervous system drive (responsible for fight-or-flight responses) as well as predisposition to cardiovascular dysfunction. Higher oxidative stress, anxiety, depression and sleep disturbances reported by postmenopausal women also play a role.
Heart attack
Both coronary artery disease (a common type of heart disease) and a myocardial infarction (heart attack) are the most severe, life-threatening causes of chest pain in a woman. These should be addressed by medical professionals as quickly as possible. It is important to note, though, that women do not always present with classic symptoms of chest pain in this case, explains Dr. Serwer.
"They are more likely to have shortness of breath, nausea, indigestion or upper abdominal pain," he says. "Because their symptoms may be different from a classic presentation, the time to diagnosis may be delayed."
Other common signs of a heart attack that may accompany chest pain in women include pain or discomfort in one or both arms, the back, neck, jaw or stomach, breaking out in a cold sweat or lightheadedness.
When women should see a doctor for chest pain
It is crucial to pay attention to your body and address chest pain promptly no matter the cause, says Dr. Serwer.
"Don't ignore symptoms, especially if the symptoms start suddenly," he advises. "Seek medical attention and raise the concern that you may be afraid you're having a heart attack."
It's also important to be proactive, he says, so be aware of your individual risks for developing heart disease such as other medical conditions and family history. You can start modifying your risk early with guidance from your doctor.