The most common heart condition in women is coronary heart disease, the narrowing of the heart’s arteries that causes angina and heart attacks. More than 800,000 women in the UK are living with it, and the British Heart Foundation reports that it kills twice as many women as breast cancer each year. Women are also commonly affected by high blood pressure, atrial fibrillation, heart failure and heart valve disease, along with several conditions that are seen far more often in women than men, such as spontaneous coronary artery dissection, microvascular angina and coronary artery spasm.

Heart disease in women is often recognised later than in men. Symptoms can be less typical, risk tends to rise after the menopause, and some of the conditions that mainly affect women do not show up on the tests traditionally used to diagnose heart disease. Knowing which conditions to look out for, and which symptoms to take seriously, makes a real difference to how quickly the right diagnosis is made.

Coronary heart disease

Coronary heart disease develops when fatty plaque builds up in the arteries supplying the heart, reducing blood flow. It can cause angina, which is chest pain or tightness on exertion, and if a plaque ruptures and a clot forms, it causes a heart attack.

Women in the UK have roughly half as many heart attacks as men, and many of the risks are shared, but women who do have one face particular challenges. The British Heart Foundation notes that women sometimes experience less familiar symptoms rather than classic chest pain, which can delay care. Some heart attacks cause so few symptoms that they are only found later, which is known as a silent heart attack.

Symptoms that women report more often include the following.

• Pain or discomfort in the jaw, neck, back or arms rather than the centre of the chest
• Breathlessness
• Nausea or vomiting
• Unusual tiredness
• A feeling of indigestion that does not settle

In our experience, women are more likely than men to put these symptoms down to stress, a stomach upset or simply being busy, and to wait before seeking help. We’ve found that a clear conversation about what counts as a warning sign is one of the most useful parts of any assessment for a woman with risk factors.

Microvascular angina

Microvascular angina is caused by problems in the heart’s tiniest blood vessels rather than the main coronary arteries. These small vessels either fail to widen when the heart needs more blood, or go into spasm.

It is more common in women, particularly around and after the menopause. Because the small vessels cannot be seen on a standard coronary angiogram, women with microvascular angina are sometimes told their heart is normal when they continue to have genuine chest pain. Diagnosis may involve a stress echocardiogram, a cardiac MRI or specialist testing during an angiogram. Lifestyle changes and medicines can improve symptoms significantly once the condition is recognised.

From working with patients who have been told their arteries are clear but whose chest pain continues, we’ve found that taking those symptoms seriously and looking beyond the main arteries often leads to a diagnosis that finally explains what they have been feeling.

Spontaneous coronary artery dissection (SCAD)

SCAD is a tear in the wall of a coronary artery, which can block blood flow and cause a heart attack. At least 80 per cent of people with SCAD are women, and it most often affects women between 45 and 53. It can also happen during or soon after pregnancy. Many women with SCAD have none of the usual risk factors, such as high cholesterol, smoking or diabetes.

In September 2026, a new international definition of heart attacks recognised SCAD, coronary artery spasm and coronary embolism as primary types of heart attack. The British Heart Foundation welcomed the change because it should mean these conditions, which mainly affect women, are diagnosed and treated with the same priority as heart attacks caused by blocked arteries.

Coronary artery spasm

In coronary artery spasm, a heart artery suddenly tightens and cuts off blood flow to part of the heart muscle. It can be triggered by emotional stress, exercise or extreme cold, and it often causes chest pain at rest, sometimes at night or early in the morning. It is more common in women and can be missed if the arteries look normal between episodes.

High blood pressure

High blood pressure is one of the most important risk factors for heart attack, stroke and heart failure in women. It often causes no symptoms, so regular checks matter. Blood pressure tends to rise after the menopause, and women who had high blood pressure or pre-eclampsia during pregnancy have a higher risk of developing high blood pressure and heart disease later in life.

Atrial fibrillation

Atrial fibrillation is the most common heart rhythm problem, causing an irregular and often fast heartbeat. It becomes more common with age and raises the risk of stroke, so an irregular pulse is always worth checking, even if you feel well.

Heart failure

Heart failure means the heart is not pumping as well as it should. In women it is more often a type where the heart muscle has become stiff rather than weak, linked to high blood pressure, diabetes and being overweight. Symptoms include breathlessness, ankle swelling and tiredness, which can easily be put down to age or lack of fitness.

How the menopause and pregnancy affect heart health

Oestrogen has a protective effect on blood vessels before the menopause. Once oestrogen levels fall, cholesterol and blood pressure tend to rise and the risk of coronary heart disease increases. This is one reason heart screening programmes often suggest checks from around age 50 for women, compared with around 40 for men.

Pregnancy can also reveal future risk. Women who had pre-eclampsia, gestational diabetes or high blood pressure in pregnancy have a higher lifetime risk of heart disease, even if everything returned to normal after the birth. It is worth mentioning these to your doctor at any heart health check.

When to see a cardiologist

See a doctor promptly if you have chest pain or tightness, pain spreading to the jaw, neck, back or arms, unexplained breathlessness, palpitations, fainting or swelling in the ankles. Call 999 if you think you might be having a heart attack, even if the symptoms feel different from what you expected.

A cardiology assessment is also worth considering if you have risk factors such as a family history of heart disease, high cholesterol, high blood pressure, diabetes, a history of pre-eclampsia, or if you are post-menopausal and want a clear picture of your heart health.

In our experience, a structured heart screening works better than waiting for symptoms for women with a strong family history because coronary heart disease can be well advanced before it causes any warning signs, and spotting risk early gives far more options for prevention.

Heart screening for women in Tunbridge Wells

At our Warwick Park practice in Tunbridge Wells, our HeartScreen programme includes a consultation and examination, an ECG, a cholesterol test, an echocardiogram and an exercise stress test, with an optional CT coronary calcium score. The screening takes around two hours and finishes with a review consultation and a detailed written report. We offer screening clinics each week, including some evening and Saturday appointments.

Since the practice opened in 2006, our consultant cardiologists have looked after patients across Kent and East Sussex, and they continue to hold NHS posts at Tunbridge Wells Hospital and King’s College Hospital.

Conclusion

The common heart conditions in women include coronary heart disease, high blood pressure, atrial fibrillation and heart failure, as well as conditions seen more often in women such as microvascular angina, SCAD and coronary artery spasm. Women’s symptoms can be less typical, and risk rises after the menopause, so it pays to take new symptoms seriously and to know your own risk factors.

If you would like your heart checked, West Kent Cardiology Partnership offers assessments and our HeartScreen programme in Tunbridge Wells. Contact us or call 01892 526726 to book an appointment.