Coronary symptoms less obvious among women: ER docs take note

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It has long been known that women having a heart attack, or other conditions due to coronary artery disease (ACS: acute coronary syndrome) complain of classic symptoms of chest pain less frequently than do men. Doctors in training are often warned about this potentially tragic atypical presentation by their more experienced mentors, ie, to not be lulled into a sense of false security when a woman comes to the ER with vague symptoms such as palpitations, shortness of breath, sweating and nausea but without the mid-chest pressure typical of ACS. Even their electrocardiograms (EKG) can fool less experienced caregivers, as the typical findings of heart attack (AMI, acute myocardial infarction) may be absent. Further, heart patients who present without chest pain have a higher rate of mortality than the typical patient.

Now, a new study by a group of Canadian physicians based in several hospital centers lends more credence to that advisory. Published in this week s JAMA Internal Medicine, the scientists, led by Nadia A. Khan, MD, from the University of British Columbia in Vancouver, evaluated 1,501 younger heart patients who were hospitalized for MI/ACS. All the studied patients were under 55 years of age, and 30 percent were women (the median age was 49). Almost one-fifth of the female patients (19 percent) did not have chest pain upon diagnosis, compared with only 13.7 percent of the males. However, those women without pain had similar findings in terms of extent of coronary artery disease and size of heart damage done.

The researchers wrote that while it remains true that chest pain is by far the most common symptom signaling acute heart trouble, health care providers should still maintain a high degree of suspicion for ACS in younger patients, particularly women, given that one in 5 women with diagnosed ACS do not report with chest pain.

An editorial in the same journal by two cardiologists from Brigham and Women s Hospital in Boston emphasize that cogent advice: ...it is prudent for public health messages to target both men and women regarding ACS symptom presentation with or without chest pain so as to encourage earlier and more widespread access to appropriate and lifesaving care.