New global heart attack definition aims to close diagnostic gap for women

Nadene Hall was 47, fit, and had done everything right. She exercised regularly, managed her health, and had none of the traditional warning signs that might have alerted her to cardiac risk. On the morning of March 25, 2023, she was finishing a strength session at the gym when she felt a cramp spread across her chest. Walking to the car park, she grew clammy and hot. Her left hand tingled. By the time she got home, nausea set in. She vomited, called an ambulance, and learned she had suffered a heart attack—not from blocked arteries or high cholesterol, but from a spontaneous tear in a coronary artery, a condition called SCAD that she had never heard of before.

SCAD, spontaneous coronary artery dissection, is a type of heart attack caused by a tear in the wall of a coronary artery. It strikes predominantly women who have few or none of the conventional risk factors: no smoking history, no family history of heart disease, no high blood pressure or diabetes. An Australian study found that nearly one in four acute coronary syndrome events in women under 60 were caused by SCAD. Yet the condition remains easy to misdiagnose. Clinicians sometimes attribute it to menopause, extreme stress, or childbirth—explanations that delay proper treatment and can cost lives.

This diagnostic blind spot is one reason why a new global definition of heart attack, published recently in the European Heart Journal, matters. The definition reorganizes how clinicians classify and think about heart attacks. It separates them into three categories: primary and sudden attacks caused by reduced blood flow to the heart; secondary attacks triggered by an acute medical condition; and procedure-related attacks following a cardiac intervention. More importantly, it includes two changes designed specifically to catch cases like Hall's. First, it recommends sex-specific troponin ranges. Troponin is a protein the heart releases when it is damaged or inflamed; doctors measure it in the blood to confirm a heart attack. But troponin levels differ between men and women, and using sex-specific thresholds helps clinicians detect attacks in women that might otherwise be missed. Second, the guidelines now group coronary events more common in women—like SCAD—alongside the primary type of heart attacks, making it easier for emergency room clinicians to consider less common causes when a woman presents with heart attack symptoms.

Experts in Australia say these changes align with what their own clinical guidelines already recommend, putting the country ahead of many others. Natalie Raffoul, head of clinical strategy at the Heart Foundation, said the update would help improve diagnosis in women for exactly these reasons. Tom Marwick, a professorial research fellow at Baker Heart and Diabetes Institute, called it a "good update" that considered the underlying cause of a heart attack and made it easier to communicate with patients. Julie Redfern, a Bond University professor of public health who contributed to Australia's guidelines, emphasized that the changes reflect what research has long shown: women and men can experience heart attacks differently. Women are more likely than men to report non-chest pain symptoms—nausea, vomiting, shortness of breath, indigestion, dizziness, or pain in the arm, jaw, neck, shoulder, or back. A 2025 study found that Australian women having a heart attack were less likely to be promptly diagnosed and treated compared to men.

Yet the new guidelines, while important, do not solve the full problem. Raffoul acknowledged a "significant treatment gap for women" that persists even when diagnosis is correct. Women are less likely to receive best-practice treatment within the required timeframe—less likely to receive a stent or balloon angioplasty when needed, less likely to be prescribed preventive medicines after diagnosis, and less likely to be referred to or attend cardiac rehabilitation. Redfern noted that some women are still "falling through the cracks," not being diagnosed or treated in a timely fashion. She called for better adherence to the guidelines and a move away from "one-size-fits-all" approaches to cardiovascular disease, emphasizing that each patient deserves treatment tailored to the type of heart attack they experienced and their individual circumstances.

Hall, now aware of her condition and its risks, wants other women—especially healthy, young women like herself—to know the warning signs and to trust their instincts when something feels wrong. The new global definition may help clinicians recognize cases they might otherwise miss. But closing the gap between diagnosis and treatment, between guidelines and practice, remains the work ahead.