Contrary to Common Belief, Women Feel Same Heart-Attack Symptoms as Men

From Heartwire
Reed Miller

October 27, 2009 (Edmonton, Alberta) — Women are as likely as men to feel chest pain or other typical heart-attack symptoms, a study presented October 26, 2009 here at the Canadian Cardiovascular Congress shows [1].

In the study, presented by critical-care nurse Martha Mackay (University of British Columbia School of Nursing, Vancouver), 305 patients (39.7% women, average age 64) undergoing a nonemergent PCI were asked a series of open-ended questions about their sensations and experience while the angioplasty balloon was creating an ECG-evident ischemia.

Women and men were equally likely to report chest discomfort or other "typical" symptoms of acute coronary syndrome, regardless of ischemic status. However, women were significantly more likely to report nonchest discomfort such as pain in the neck, jaw, and throat. Older patients were more likely to report chest or throat discomfort. Patients who had undergone a PCI before were more likely to report jaw pain, and prior MI and older age increased the likelihood of neck pain.

Countering Common Misperceptions

Even as professional organizations such as the American Heart Association (AHA) have made a major push to make women aware of their risk for cardiovascular disease, the perception that women's heart-attack symptoms are different from men's persists. Recent retrospective research--subject to recall bias and the usual problems associated with reliance on written medical records--has suggested that this perception is misguided, so Mackay and her colleagues chose to conduct this study because the question "hadn't really been settled."

To rectify the methodological issues of the previous research, Mackay's group developed their questions for the study subjects carefully to ensure they weren't influencing them to report a particular symptom. For example, they did not tell the patients they were studying ACS symptoms but instead told them they were researching patients' overall experience during PCI.

The study underlines the importance of public-education campaigns aimed at women such as the AHA's Go Red for Women campaign or the Heart Truth campaign run by the Heart and Stroke Foundation in Canada, Mackay said.

The study also suggests a need for new protocols and tools that will help health providers get a better understanding of patients' symptoms. Patients may not say they are feeling chest pain if another pain is more dominant. So providers must ask questions that elicit a more complete description of the patient's symptoms in order to make an accurate diagnosis, she explained.