How Heart Attacks & Stroke Differ in Assigned Female at Birth Individuals

Cardiovascular diseases and stroke affect an estimated 44 million assigned female at birth individuals (AFAB) in the United States. While these conditions are relevant to everyone, individuals AFAB have a higher lifetime risk of stroke than assigned male at birth individuals and fewer AFAB individuals than those assigned male survive their first heart attack. It’s important to note symptoms of a heart attack vary widely between sexes and are often misunderstood in individuals AFAB, even by doctors.

Understanding the Terminology

Many of the terms below are used interchangeably in conversation, but they’re very different conditions, although closely linked.

Heart Disease

Heart disease, or cardiovascular disease, generally refers to conditions involving narrowing, hardening, and/or blocking of blood vessels and arteries that can in turn lead to a heart attack or stroke. Other conditions, such as those that effect your heart muscle, valves, or rhythm are also considered forms of heart disease.


A stroke, sometimes referred to as a ‘brain attack,’ happens when a blood vessel supplying the brain gets clogged or bursts, cutting off blood flow and oxygen to the brain.

An ischemic stroke, the most common type, occurs when plaque buildup in the carotid arteries cuts off blood supply to the brain.

Caused by high blood pressure straining the walls of the arteries, a hemorrhagic stroke occurs when a blood vessel in the brain ruptures and blood leaks into the surrounding tissues.

Heart Attack

A heart attack occurs when blood flow to the heart is blocked, usually by a blood clot or when a coronary artery becomes blocked or narrowed to the point blood flow stops or is severely restricted.

Link Between Them

Several types of heart/cardiovascular diseases are risk factors for stroke and vice versa. They also share many of the same risk factors, such as high LDL, or ‘bad,’ cholesterol levels; low HDL, or ‘good,’ cholesterol levels; high blood pressure; smoking; diabetes; physical inactivity; weight; age; and family history.

The Difference Between Sexes: Signs & Symptoms

Signs and symptoms of heart attack and stroke vary between sexes, as AFAB individuals often have symptoms that are misunderstood.

Heart Attack

For those assigned male at birth, the telltale sign of a heart attack tends to be excessive chest pain and tightness, while in AFAB individuals it’s normal to experience a heart attack without any chest pain.

AFAB individuals may exhibit very subtle signs of heart attack, often confused as symptoms of other medical conditions.

Symptoms to lookout for include:

  • Severe acid reflux
  • Extreme shortness of breath, with or without chest discomfort
  • Upper back pressure and pain
  • Pressure, fullness, or pain in the center of your chest that persists for several minutes or goes away and comes back
  • Pain or discomfort in one or both arms, the back, neck, jaw, or stomach
  • Dizziness, lightheadedness, and fainting
  • Nausea and/or vomiting
  • Breaking out in a cold sweat


Gender differences for stroke symptoms also vary, with research finding AFAB stroke victims are 33% less likely than their assigned male counterparts to report a classic stroke symptom when they arrive in the emergency room. Unique symptoms again pose a problem, as even doctors may misdiagnose stroke symptoms in AFAB individuals for other medical conditions.

Some symptoms to be on the lookout for:

  • The five classic stroke warning signs include sudden:
    • Numbness or weakness of the face, arm, or leg, especially on one side
    • Confusion and/or difficulty speaking
    • Vision issues
    • Difficulty with walking, dizziness, or loss of balance
    • Severe headache
  • Fainting or loss of consciousness
  • Difficulty breathing
  • Pain, generalized or specific to the head/upper body
  • Seizures
  • General weakness
  • Sudden behavioral change, agitation
  • Hiccups

As with heart attacks, time is of the essence in treating strokes. Remember the acronym “BE FAST” to help with identifying a possible stroke and be sure to seek immediate medical attention.

Balance—is there a sudden loss of balance or coordination?

Eyes—is there sudden blurred vision, double vision, or difficulty seeing?

Face—ask the person to smile; is there a droop on one or both sides of the face?

Arms—ask the person to raise both arms up; does one arm drift downward or show weakness?

Speech—does the person have slurred speech or show difficultly repeating simple phrases?

Time—call 911 for immediate medical attention if you notice one or more of these signs and note when symptoms began.

By being aware of how symptoms for stroke and heart attacks present in different genders, you’ll be better equipped to help others and yourself in times of medical emergency. When in doubt, trust your intuition and visit an urgent care or primary care provider for diagnosis.

The experts at NWPC offer a variety of cardiac testing and monitoring services to help keep you healthy and provide you with care that fits your needs.

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