If I asked you to picture someone having a heart attack, you would probably imagine a middle-aged man clutching his chest. That image, repeated endlessly on screen, has taken such deep root that many of us still believe heart disease "doesn't happen to women". And that misconception is costing us dearly.

The leading cause of death in women (even if it doesn't feel that way)

Cardiovascular disease is the leading cause of death among women in Europe. More women die of heart and circulatory problems than of many cancers combined — including breast cancer. And yet, when I ask patients in clinic which disease worries them, hardly anyone mentions the heart.

This misperception has real consequences: we seek help later, we put our symptoms down to other causes, and the diagnosis often arrives when the disease has been progressing for some time. Changing that mindset is the first step towards protecting ourselves.

A woman's heart doesn't fall ill less often — it shows itself differently. And that is precisely why it deserves to be listened to with care.

A heart attack that doesn't always hurt in the chest

The classic symptom of a heart attack — crushing pressure in the centre of the chest, sometimes spreading to the left arm — does occur in women too. But in us, both heart attacks and angina (the pain that warns us the heart is not getting enough blood) more often show up in less "typical" ways:

Breathlessness (dyspnoea) out of proportion to the effort involved.
Unusual fatigue, sometimes appearing days or weeks beforehand.
Nausea or discomfort in the upper abdomen (the epigastrium).
Pain in the jaw, neck, back or between the shoulder blades.
A vague, hard-to-describe malaise, often with cold sweats or a sense of dread.

Why are women diagnosed later? Partly because these symptoms are easily mistaken for anxiety, digestive trouble or "just the menopause". And partly because women's coronary arteries tend to be narrower, and the disease may mainly affect the smallest vessels (so-called microvascular disease), which doesn't always show up on standard tests. Many of us play down what we feel until we can no longer ignore it.

Risk factors specific to — or more common in — women

Beyond the classic risk factors — smoking, high blood pressure, cholesterol, diabetes, a sedentary lifestyle — there are circumstances specific to women, or more common in women, that leave their mark on the arteries:

The menopause. Oestrogen offers the blood vessels a degree of protection. As levels fall, cholesterol, blood pressure and abdominal fat tend to rise, and risk accelerates.
Pregnancy complications. A history of pre-eclampsia, gestational hypertension (high blood pressure in pregnancy) or gestational diabetes increases future risk. Pregnancy acts as a natural "stress test": if something went wrong then, it deserves watching afterwards.
Polycystic ovary syndrome. It is linked to insulin resistance and a higher metabolic and cardiovascular risk.
Migraine with aura. It is associated with an increased risk of stroke, particularly when combined with smoking or certain contraceptives.
Cancer treatments. Some chemotherapy drugs, and radiotherapy to the chest — such as those used for breast cancer — can affect the heart years later; a dedicated discipline, cardio-oncology, keeps watch over it.
Autoimmune diseases. Lupus and rheumatoid arthritis, both more common in women, sustain a chronic inflammation that damages the arteries too.

Recognising yourself in any of these doesn't mean you will fall ill — it means your heart deserves closer follow-up.

Symptoms you should never normalise

There are warning signs none of us should ever simply put down to stress, age or tiredness:

Breathlessness during activities you used to manage easily, such as climbing stairs or walking briskly.
Intense, new fatigue with no clear explanation.
Pain or pressure in the chest, jaw, neck, back or upper abdomen — especially if it comes on with exertion or emotion and eases when you stop.
Palpitations accompanied by dizziness, or any loss of consciousness.
Swelling of the legs and ankles that keeps getting worse.
Nausea or cold sweats together with chest discomfort.

Very important: if a symptom is severe, comes on suddenly or appears at rest, don't wait for an appointment — call 112. My clinic works by scheduled appointment and does not handle emergencies; in an emergency, every minute counts.

Prevention tailored to every stage of life

A woman's heart changes over the decades, and prevention should change with it:

In your twenties and early thirties: build solid habits — not smoking, moving every day, eating well — and know your blood pressure. If you have migraine with aura and you smoke or take contraceptives, discuss it with your doctor.
During and after pregnancy: if you had pre-eclampsia, gestational hypertension or gestational diabetes, don't file it away as a closed chapter: it deserves regular checks of blood pressure, glucose and cholesterol.
Between 40 and 55: the perimenopause is the key moment for a full cardiovascular assessment — blood pressure, cholesterol, glucose and weight, without forgetting sleep, stress and exercise.
From the menopause onwards: keep your check-ups regular. Never assume that breathlessness or tiredness are "just your age" without having it looked into.

Women's heart health: a special focus of my practice

Women's cardiovascular health is one of the areas I care for with particular interest. In my clinics in Valencia and Dénia I take time to piece together your full story: not just your cholesterol and blood pressure, but your pregnancies, when your menopause began, your treatments and your family history. All of it shapes your true cardiovascular risk.

If you have recognised yourself in any of these symptoms or risk factors — a complicated pregnancy, the menopause, cancer treatment — asking for a cardiology assessment is not overreacting: it is looking after yourself wisely. As I often say, the best medicine is good prevention, and nowhere is that truer than in a woman's heart. Your heart has been listening to you all your life; perhaps the moment has come for you to listen back.

Sources and further reading

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This article is for information only and does not replace individual assessment or advice from a healthcare professional. For acute symptoms such as severe chest pain, call 112.

Women's hearts: symptoms we should never dismiss