By: Dr. Avi Verma 

Heart attacks are often thought of as a concern for older adults, but new research shows that women under 65 are at risk too — even if they appear healthy and have no traditional cardiovascular issues. Subtle symptoms like mild chest discomfort, sudden sweating, or palpitations during menopause could signal something more serious. Recent studies reveal that many heart attacks in younger women arise from nontraditional causes, such as spontaneous coronary artery dissection (SCAD) or conditions that upset the heart’s oxygen balance, rather than the clogged arteries typically associated with heart disease. Awareness and timely action can make all the difference in protecting heart health.

Nontraditional heart attack causes in younger women

A recent study led by researchers at Mayo Clinic found that nearly half of heart attacks among women under 65 were due to nontraditional causes. SCAD — a tear in the coronary artery wall — was one of the leading factors. Other contributors included anemia, untreated infections, and takotsubo syndrome (also called “broken heart syndrome”), which occurs when extreme stress disrupts blood flow to the heart.

Dr. Claire Raphael, MBBS, PhD, an interventional cardiologist at Mayo Clinic, emphasized: “The women who are most likely to have a nontraditional cause of heart attack are those without traditional risk factors. Women under 45 are at the highest risk, and SCAD is relatively common in this group.”

SCAD primarily affects young, otherwise healthy women, though the exact reason is still unclear. Often misdiagnosed as plaque-related clots or labeled as MINOCA (myocardial infarction with nonobstructive coronary arteries), SCAD is a significantly underrecognized threat. Cardiologist Dr. Janet Wei of Cedars Sinai noted that SCAD caused roughly 1 in 10 heart attacks in women, nearly six times more often than in men.

Why accurate diagnosis matters

Understanding the underlying cause of a heart attack is essential to receive the correct treatment. Dr. Rajiv Gulati, MD, PhD, chair of Interventional Cardiology at Mayo Clinic, explained: “Traditional heart attacks caused by blocked arteries often require interventions like balloon angioplasty and stent placement. But with SCAD, stents can sometimes worsen the tear, so careful evaluation is critical.”

Women who experience a heart attack should consider asking their doctor:

• What did the angiogram show, and could this be SCAD?
• What is the suspected underlying cause? (Particularly important for MINOCA cases.)
• Would a cardiac MRI help confirm a diagnosis?

Traditional risk factors still matter

For women with diabetes, high cholesterol, high blood pressure, or a smoking history, atherosclerosis remains a significant risk, accounting for about half of heart attacks in women. Recognizing both traditional and nontraditional warning signs is crucial.

Recognizing symptoms early

Women’s heart attack symptoms can differ from men’s. While chest pain is classic, other signs include:

• Ache in both shoulders
• Jaw pain, especially when moving
• Nausea or vomiting
• Unusual fatigue or inability to perform daily activities
• Shortness of breath

Takeaway

Even if you are under 65 and appear healthy, don’t ignore subtle warning signs. Early recognition, prompt evaluation, and understanding the underlying cause can significantly improve outcomes for women facing hidden heart risks.

Disclaimer: This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of your physician or other qualified health provider with any questions about a medical condition.