Why do women with a heart attack but no chest pain die so often?

Do they?: Your question implies that their condition goes unrecognized and, perhaps, there is some truth to that. Women's presentation is sometimes atypical and harder to spot. Also women's mortality from heart attack is statistically a little higher than men, but the reasons are complex and there isn't space here to fully review them.

Atypical symptoms: Likely because symptoms aren't typical and aren't recognized early enough by patient or medical provider for effective intervention.

Number of reasons: Mortality from heart attacks is related to age. Women develop heart disease, on average, 10 years later than men. Women are more likely to present with atypical symptoms that are not recognized either by the patient or the physician. This can result in a delayed diagnosis or missed diagnosis.