Sept. 15, 2025 — Is it just heartburn, or something more serious? Menopausal heart palpitations and sudden sweating, or signs of a heart attack?
If you’re a woman under 65, science just gave you a new reason to pay attention to ambiguous symptoms — even if you don’t have traditional risk factors for a heart attack.
In a new study, Mayo Clinic researchers found that half of heart attacks among younger and middle-aged women were not due to atherosclerosis (clogged arteries) but rather to nontraditional causes — mainly, spontaneous coronary artery dissection (SCAD), which is when a tear in the artery wall creates a blockage, or conditions that disrupt the balance between the heart’s oxygen demand and supply.
The findings highlight three important takeaways for women:
1. Even if you’re young and think you’re in good health, you should still be aware of the signs of a heart attack, especially subtle ones.
Women with a clean bill of cardiovascular health, such as good cholesterol tests or an optimal blood pressure reading, may dismiss the possibility of a heart attack. But this is the very group who can experience heart attacks from nontraditional causes.
“The women who are most likely to have a nontraditional cause of heart attack are those without traditional risk factors,” said study co-author Claire Raphael, MBBS, PhD, an interventional cardiologist at Mayo Clinic. “Women under age 45 are at the highest risk for a nontraditional heart attack, and in this group, diagnoses like SCAD are relatively common.”
SCAD mainly affects young, healthy women, though scientists aren’t sure why.
Sometimes mistaken as a clot caused by plaque — or misclassified as MINOCA (myocardial infarction with nonobstructive coronary arteries) — SCAD is an underrecognized threat, especially in women, said cardiologist Janet Wei, MD. In the study, SCAD caused 1 in 10 heart attacks among women, “which is significant given SCAD was nearly six times more common in women than men,” said Wei, who specializes in women’s heart health at Cedars Sinai in Los Angeles and was not involved in the study.
Other nontraditional contributors included anemia, untreated infection, and takotsubo syndrome — so-called broken heart syndrome, which is linked to extreme stress or emotions and happens when blood flow to the heart is disrupted. All can cause imbalances in the heart’s oxygen demand and supply.
2. If you have a heart attack earlier in life, accurately diagnosing the underlying cause is important — so you get the right treatment.
“We treat traditional heart attacks differently to nontraditional heart attacks,” said the study’s senior author Rajiv Gulati, MD, PhD, chair of the Division of Interventional Cardiology and Ischemic Heart Disease at Mayo Clinic. For a heart attack caused by severe narrowing due to atherosclerosis, doctors typically treat with a balloon angioplasty and stent placement to restore blood flow to the heart, Gulati said.
With SCAD, “there is some risk that stents can make the dissection worse, so we are much more cautious before embarking on coronary intervention,” Gulati said.
In the study, most of the SCAD-related heart attacks were misdiagnosed. Gulati and Raphael suggested that women who have a heart attack ask their doctor the following questions:
- What did the angiogram show and could this be SCAD?
- What do you think is the underlying cause? (This is particularly important if you’ve been told you have MINOCA, a broad label that indicates a heart attack without major artery blockages but doesn’t explain the underlying cause.)
- Would a cardiac MRI be helpful to make a specific diagnosis?
3. If you have traditional risk factors, stay alert — they remain a common cause for heart attacks among women.
If you have diabetes, high cholesterol, or high blood pressure — or you smoke — then atherosclerosis remains a likely threat, contributing to half of heart attacks among women in this latest analysis, Raphael said.
All women should be aware of heart attack symptoms, said Wei, especially since they can look different from men’s symptoms.
Chest pain is the classic sign, but other symptoms include:
- Both shoulders ache
- Jaw pain, particularly when moving
- Nausea and vomiting
- Feeling like you can’t do your usual activities
- Shortness of breath
