New Heart Attack Definition Could Improve Diagnosis and Treatment for Women

A major change in the way heart attacks are defined could improve diagnosis and treatment for thousands of women in the UK and millions of people worldwide.

New international guidance unveiled at the European Society of Cardiology Congress in Munich places greater emphasis on several less common types of heart attack that predominantly affect women. The updated approach is expected to help doctors identify these conditions more accurately and ensure patients receive treatment that matches the underlying cause.

The changes form part of the Fifth Universal Definition of Myocardial Infarction, developed by leading international cardiovascular organisations following decades of research. The new definition gives greater recognition to three types of heart attack: coronary artery spasm, coronary embolism and spontaneous coronary artery dissection, commonly known as SCAD.

Why the new heart attack definition matters

Heart attacks are often associated with a blocked coronary artery caused by a blood clot. However, not every heart attack develops in this way.

Some less common heart attacks can have very different causes, and these conditions have historically been classified differently. Experts believe this may have contributed to some patients receiving less appropriate attention, diagnosis or treatment.

The new guidance aims to put these causes on a more equal footing with what are traditionally regarded as common or severe heart attacks.

One of the most important recommendations is that suspected primary heart attacks should be confirmed with appropriate imaging, including an angiogram where suitable. An angiogram can provide detailed images of the coronary arteries and may help doctors identify problems that could otherwise be missed.

This could be particularly important for women experiencing heart attacks linked to conditions such as SCAD or coronary artery spasm.

Three heart attack causes affecting many women

1. Coronary artery spasm

A coronary artery spasm occurs when an artery supplying blood to the heart suddenly tightens. This can reduce or temporarily restrict the flow of blood and oxygen to the heart muscle.

Several factors may contribute to coronary artery spasm, including emotional stress, physical activity and exposure to extreme cold.

Although it is less common than a heart attack caused by a conventional blockage, coronary artery spasm can still cause significant heart damage and requires appropriate diagnosis and treatment.

The new classification could help doctors distinguish this condition from other causes of heart attack, allowing treatment to focus on relaxing and widening the affected blood vessels.

2. Coronary embolism

A coronary embolism happens when a clot or another material travels through the bloodstream and becomes lodged in a coronary artery.

The resulting blockage can reduce blood flow to the heart and cause a heart attack.

Because the cause is different from the more familiar build-up of fatty deposits in the coronary arteries, treatment may also need to be different. Correctly identifying a coronary embolism could therefore help doctors select medication and other treatments that address the underlying problem.

3. Spontaneous coronary artery dissection, or SCAD

SCAD is a particularly important condition when discussing heart attacks in women.

It occurs when a tear develops suddenly within the wall of a coronary artery. This can interfere with blood flow to the heart and trigger a heart attack.

According to the British Heart Foundation, around 80 percent of SCAD cases occur in women. The condition can also occur during or shortly after pregnancy.

SCAD can happen unexpectedly, including in people who may not have the traditional risk factors commonly associated with coronary heart disease. This makes awareness and rapid diagnosis especially important.

A patient's experience highlights the importance of diagnosis

The impact of accurate diagnosis can be seen in the experience of Allison Lawson, who suffered a SCAD-related heart attack at the age of 51.

Her symptoms began with extreme tiredness and unusual discomfort in the centre of her chest. The discomfort developed into pain that travelled down her left arm and towards her jaw.

Within around 30 minutes, she was being taken to hospital by ambulance.

Allison had never heard of SCAD before experiencing her heart attack. She later spent three days in a cardiac intensive care unit while recovering from the event.

Her experience demonstrates why greater awareness of less common heart attack causes is important. Knowing what has happened can help patients understand their condition, participate in treatment decisions and recognise potential warning signs in the future.

Could the new guidance change heart attack treatment?

One of the biggest potential benefits of the updated definition is that patients may be less likely to receive treatment that does not address the actual cause of their heart attack.

For example, a person whose heart attack is linked to coronary artery spasm may require medication that helps relax blood vessels rather than certain medicines that could be less appropriate in that situation.

Similarly, treatment for a coronary embolism may need to focus on preventing or treating blood clots. For someone who has experienced a SCAD-related heart attack, managing factors such as blood pressure may be an important part of their care.

This highlights why identifying the specific cause of a heart attack matters. A diagnosis is not simply a label. It can influence decisions about medication, monitoring and longer-term care.

Gender differences in heart attack diagnosis

Another important aspect of the new guidance is the recognition that men and women can have different troponin levels.

Troponin is a protein released into the bloodstream when the heart muscle is damaged. Doctors use blood tests measuring troponin as an important part of assessing whether someone may have had a heart attack.

Research supported by the British Heart Foundation has shown that women generally have lower troponin levels than men.

Using appropriate sex-specific thresholds can therefore help reduce the risk of heart attacks being overlooked in women.

This is significant because delayed or missed diagnosis can affect access to appropriate treatment and follow-up care.

The updated definition encourages hospitals to distinguish between male and female thresholds when assessing troponin, with experts hoping that this approach will become more widely adopted internationally.

What the new heart attack categories mean

The updated definition also aims to make heart attack categories easier to understand.

Primary heart attacks now include the less common causes described above, while secondary heart attacks refer to heart attacks triggered by another illness or physical stress that causes the heart's oxygen demands to exceed the available supply.

There is also a category for heart attacks associated with medical procedures, such as coronary stent placement or coronary artery bypass surgery, when they occur within the specified period following the procedure.

The goal is to provide clearer definitions for healthcare professionals while also helping patients understand what happened to their heart.

A potential turning point for women's heart health

For decades, heart disease has often been viewed primarily through the lens of research and symptoms that are more commonly recognised in men.

The new heart attack definition represents a significant move towards recognising that cardiovascular disease can affect women differently.

Greater recognition of SCAD, coronary artery spasm and coronary embolism could lead to better diagnosis, more appropriate treatment and increased research into these conditions.

Improved data collection may also help scientists understand why these heart attacks occur, who is most at risk and which treatments provide the best outcomes.

For women experiencing symptoms of a heart attack, however, the most important message remains the same: do not ignore potential warning signs. Chest pain or discomfort, pain spreading to the arm or jaw, breathlessness, sweating, nausea, unusual fatigue or other concerning symptoms should receive urgent medical attention.

The new international definition could be an important step towards making heart attack diagnosis more accurate and treatment more personalised, particularly for women affected by less common forms of the condition.

Source

British Heart Foundation (BHF) on 1 September 2026, concerning the Fifth Universal Definition of Myocardial Infarction and its implications for the diagnosis and treatment of heart attacks.

Medical Disclaimer

This article is provided for general information and educational purposes only. It is not intended to replace professional medical advice, diagnosis or treatment. If you or someone else is experiencing possible symptoms of a heart attack, seek emergency medical assistance immediately. Treatment decisions should always be made with a qualified healthcare professional based on an individual's circumstances.