Regardless of age or setting, women are more likely to die of a heart attack.1
Nausea and back pain are symptoms to look for.2
Hypertension, higher in those over 60,3 is linked to myocardial infarction.4
Obesity and sedentary activity are higher in females, which can worsen cardiac effects.5, 6
20-minute longer symptom-to-balloon rates occur in women.7
Biases persist as women are more likely to report feeling dismissed by physicians when they voice concerns.8
Women are also more likely to die after developing STEMI, both in-hospital and in the 5 years after diagnosis.9
Watch out for misdiagnoses:
Diagnoses for unstable angina happen more often than for STEMI,11 but aren't always correct. Women are more prone to microvascular disease than obstructive disease, which can go undetected.12
Sex-based differences can complicate angina care planning.10
Check for plaque erosion:
Women show more plaque erosion that contributes to unstable angina.
Know women's angina symptoms:
Hypertension and diabetes can cause an elevated risk of LVH.
Look out for LVH. The higher prevalence of LVH in women offsets their sex-protection against cardiovascular risk so screening is critical for protection.13
Be aware of ECG variances.
Women with diabetes have a higher risk of prolonged QTc.14
Women are more likely to experience:
Longer repolarization phases
Longer QT duration (by 10ms)
Higher heart rate (about 3-7 BPM on average)
Certain arrhythmias, such as atrioventricular nodal reentry tachycardia (AVNRT) and drug-induced torsade de pointes
Anatomical differences can complicate proper positioning.
Breast Tissue
When necessary breast tissue should be raised to allow for correct V4, V5 & V6 placement.15
Breast Implants Implants
can block voltage pathways, creating a T-wave inversion and ST depression that could be wrongly interpreted as CAD and MI.16
By understanding the cardiac risks and differences for female patients—and using ECG as a diagnostic tool—physicians can ensure more equitable care and more positive outcomes for women.
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