|Heart Attack Symptoms in Women — Are they
Chest pain is still the most common sign of a heart attack for
most women, although studies have shown that women are more likely
than men to have symptoms other than chest pain or discomfort when
experiencing a heart attack or other form of acute coronary syndrome
(ACS), according to an article "Symptom Presentation of Women
With Acute Coronary Syndromes — Myth vs. Reality" published
online Dec. 10 in the Archives of Internal Medicine. The
study was funded by the National Heart, Lung, and Blood Institute
(NHLBI) of the National Institutes of Health.
Researchers examined 35 years of research that yielded 69 studies
69 studies and found that, depending on the size of the study (which
ranged from large trials to single centers and interviews), between
30 percent and 37 percent of women did not have chest discomfort
during a heart attack. In contrast, 17 percent to 27 percent of
men did not experience chest discomfort. Overall, the majority
of women — and men — in the reviewed studies had chest
discomfort with heart attack (two-thirds to three-quarters, depending
on study size).
Study authors also found that older people are more likely to
have heart attack without chest discomfort. However, because women
are on average nearly a decade older than men at the time of their
initial heart attack, the researchers call for more studies to
determine the degree to which gender independently influences heart
They conclude that current research does not indicate a need to
differentiate heart attack symptoms in women from those in men,
and public health messages should continue to emphasize chest pain
or discomfort, shortness of breath, and other common signs of heart
attack. Coronary heart disease is the leading cause of death among
U.S. women, and affects one in 10 women over the age of 18.
The authors also report that women are more likely than men to
experience other forms of cardiac chest pain syndromes, such as
unstable angina, and they appear to report a wider range of symptoms
associated with ACS. For example, women are more likely to report
pain in the middle or upper back, neck, or jaw; shortness of breath;
nausea or vomiting; indigestion; loss of appetite; weakness or
fatigue; cough; dizziness; and palpitations.
Absence of chest discomfort is a strong predictor for missed diagnosis
and treatment delays. Noting that many studies exclude patients
who do not report chest pain, the researchers call for additional
research from well-designed studies to further investigate gender
differences in heart attack symptoms. This includes expanding symptom
definitions and greater standardization in data collection and
reporting of women's symptoms.
Study co-author George Sopko, M.D., Medical Officer with NHLBI's
Division of Cardiovascular Diseases, is available for comment.
To schedule interviews, contact the NHLBI Communications Office
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NHLBI is part of the National Institutes of Health (NIH), the Federal
Government’s primary agency for biomedical and behavioral research.
NHLBI press releases and fact sheets, including information on the
Women’s Health Initiative and on overweight and obesity can be found
online at www.nhlbi.nih.gov.
- Act In Time To Heart Attack Signs is an NHLBI education campaign
that that urges physicians to educate their patients about heart
attack risk, warning signs, and survival. For information on
heart attack warning signs for both the public and health care
- The Heart Truth, NHLBI's national awareness campaign for women
about heart disease, aims to spread the word that heart disease
is largely preventable. For midlife women, the most common risk
factors for heart disease in order of greatest prevalence include
overweight/obesity, high blood cholesterol, diabetes, and high
blood pressure. For more on The Heart Truth, http://www.hearttruth.gov.
- For current recommendations for heart health, see Your Guide
to a Healthy Heart, http://www.nhlbi.nih.gov/health/public/heart/other/your_guide/healthyheart.htm.
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