Heart Failure Often Looks Different in Women—Here’s How to Spot the Signs

Heart failure affects millions of adults in the U.S., and women often experience it differently than men. We asked Sanjana Bhatia-Patel, DO, a heart failure specialist at Main Line Health, to answer some of the most common questions women have about recognizing symptoms, managing risks and staying heart healthy.

What are the early warning signs of heart failure in women? Do they differ from men?

Dr. Bhatia-Patel: Women may experience more subtle symptoms, which can make early detection challenging. Feeling unusually tired, becoming short of breath during everyday activities, or struggling to lie flat comfortably at night to sleep can all signal that the heart may not be pumping as effectively as it should.

What lifestyle changes help prevent or slow heart failure—especially for women over 40?

Dr. Bhatia-Patel: Staying active is one of the most powerful tools. The American Heart Association recommends 150 minutes of moderate exercise or 75 minutes of vigorous exercise weekly, plus two days of muscle-strengthening activity. These habits, combined with healthy eating and stress management, lay the foundation for long-term heart health.

How do high blood pressure, diabetes and menopause affect heart failure risk?

Dr. Bhatia-Patel: Conditions like high blood pressure and diabetes can stiffen arteries over time, placing extra strain on the heart. Managing these conditions early and consistently is key.

Menopause also plays a role; declining estrogen levels remove a natural cardioprotective effect. This shift doesn’t cause heart failure on its own, but it can make women more vulnerable to rising cholesterol, weight gain, high blood pressure and insulin resistance. Modify all other controllable risks: avoid smoking, maintain a healthy weight, stay active, sleep well, and keep cholesterol, blood pressure and blood glucose within target ranges.

When should women seek care for symptoms like fatigue or shortness of breath?

Dr. Bhatia-Patel: Pay attention to patterns. If fatigue, shortness of breath or reduced activity tolerance persist for more than one to two weeks, it’s time to contact your healthcare provider. Early evaluation helps prevent symptoms from progressing.

Are there screenings women should have after age 40 to detect early signs of heart failure?

Dr. Bhatia-Patel: Yes. Regular blood pressure checks and annual cholesterol screenings are essential and can be done at your doctor’s office or at a local pharmacy. For women with high blood pressure or diabetes, doctors may order tests such as an EKG or echocardiogram to evaluate heart function. Women should also be aware of their family history. If a first-degree relative has significant heart disease, evaluation is important even in the absence of symptoms. Early detection allows for earlier, more effective treatment.

For more on heart-healthy living, visit Go Red.