New global definition of heart attack to improve outcomes for women

Nadene Hall had never heard of a spontaneous coronary artery dissection (SCAD) heart attack until she had one.

It was 7:30am on March 25, 2023, and Ms Hall was finishing up a strength-based session at the gym when she felt a cramp across her chest.

"As I was walking downstairs to the car park, I started to feel a bit hot, like clammy, and my left hand started to feel a bit tingly," she said.

Ms Hall went home feeling nauseated, vomited and then called an ambulance.

"I was 47, fit and healthy," she said.

"I do everything I can to not have a heart attack, so it was the last thing from my mind."

Ms Hall was diagnosed with SCAD, a type of heart attack caused by a tear in a coronary artery that mainly affects women with few traditional risk factors.

An Australian study suggests that nearly one in four acute coronary syndrome events in women under the age of 60 were caused by SCAD.

But the condition can be easy to misdiagnose and is sometimes associated with menopause, extreme stress or childbirth.

Experts said a new global definition of heart attack, published recently in the European Heart Journal, would help improve the diagnosis of women like Ms Hall and lead to better outcomes.

New heart attack definition

The new definition separates heart attacks into three categories depending on how the patient presented clinically:

• primary and sudden, caused by reduced blood flow to the heart
• secondary due to an acute medical condition
• procedure-related following a cardiac procedure.

Baker Heart and Diabetes Institute professorial research fellow Tom Marwick said the "good update" considered the underlying cause of a heart attack and made it easier to communicate to patients.

Heart Foundation head of clinical strategy Natalie Raffoul said the update would help improve the diagnosis of heart attacks in women for two key reasons.

Firstly, she said, the global guidelines included a recommendation for sex-specific troponin ranges.

When the heart is damaged or inflamed it releases proteins called troponin into the bloodstream, which diagnosing doctors can test for.

But troponin levels in men and women differ.

Ms Raffoil said sex-specific ranges would help doctors do a "better job at picking up heart attacks in women when they're presenting with symptoms".

The second key change Ms Raffoil said was that coronary events more common in women, such as SCAD, were now grouped with the main type of heart attacks.

"That's a great thing because that means when a woman comes to the emergency room, presenting with heart attack symptoms, clinicians can consider less common coronary events such as SCAD," she said.

Ms Raffoil said the global guidelines were closely aligned with the Heart Foundation's clinical guidelines for diagnosing and managing acute coronary syndromes in Australia.

'Significant treatment gap for women'

Cardiovascular disease is one of the leading causes of death for Australian women.

Ms Raffoil said although chest pain or pressure were the most common symptoms of a heart attack in men and women, there could be some differences between the sexes.

"Women are more likely than men to experience non-chest pain symptoms," Ms Raffoil said.

These may include:

• nausea or vomiting
• shortness of breath
• indigestion
• dizziness, or the feeling of faintness
• pain in the arm, jaw, neck and shoulder and back.

A 2025 study found Australian women having a heart attack were less likely to be promptly diagnosed and treated compared to men.

Ms Raffoil said although the new guidelines would help clinicians detect and diagnose heart attacks in women, there was still a "significant treatment gap for women".

"A woman is more less likely to receive best practice treatment and care,"

she said.

"Less likely to receive that stent or ballooning within a certain time frame, less likely to receive preventive medicines after diagnosis and also less likely to be referred to, and attend, cardiac rehab.

Treatment not 'one-size-fits-all'

Ms Raffoil said many of the updates in the global guidelines including sex-specific troponin blood test thresholds and emphasis on cardiac events more common in women such as SCAD were already included in the Heart Foundation's guidelines, putting Australia on the "front foot".

But Julie Redfern, a Bond University professor of public health who contributed to Australia's guidelines, said some women were still "falling through the cracks" and not being diagnosed or treated in a timely fashion.

"We need better adherence [to the guidelines]," she said.

Professor Redford, who specialises in heart attack survivorship, said this meant providing the best possible treatment for each patient based on factors like the type of heart attack they experienced, not offering a "one-size-fits-all" approach to cardiovascular disease.

Ms Raffoil and Professor Redford hoped the new global guidelines would encourage clinicians in Australia to learn more about heart attack causes and symptoms for women.

Ms Hall wants women — especially healthy, young women like herself — to be aware of the warning signs and reach out for help.

"Listen to your body," she said.

"We always put everyone else first. Sometimes we have to put ourselves first and get checked out."