When the topic of heart attack arises, many envision a middle aged, or older man, clutching his chest. However, each year, more than 15,000 women under the age of 55 die of heart disease in the United States, making it the leading cause of death for women in this age group. According to the Los Angeles County Department of Public Health, coronary heart disease is the leading cause of premature death (death before age 75) in women in the county. Furthermore, among younger women, those that suffer a heart attack are nearly twice as likely as men to die. A new study published on February 24 in the journal Circulation: Cardiovascular Quality and Outcomes may help explain the reason for these sad statistics.
The study authors note that prompt recognition of acute myocardial infarction (MI; heart attack) symptoms and timely treatment significantly increase the likelihood of a good outcome. They explain that relatively little is known about the initial symptoms and treatment of women 55 years of age or younger. Symptom recognition and prompt, appropriate therapy would reduce the risk of treatment delays and improve acute care for these women.
The study group comprised 30 women ranging in age from 30 t0 55 years who were hospitalized for an acute MI. The researchers conducted in-depth interviews of these women to assess their early symptoms and their decision-making process to seek medical treatment. Five themes described their experiences: (1) prodromal (early) symptoms varied significantly in both nature and duration; (2) the women inaccurately assessed personal risk of heart disease and commonly attributed their symptoms to noncardiac (not heart-related) causes; (3) competing and conflicting priorities influenced their decisions regarding seeking acute care; (4) the healthcare system was not consistently responsive to them, resulting in delays in workup and diagnosis; and (5) the women did not routinely access primary care, including preventive care for heart disease.
The authors concluded that the women in the study did not accurately assess their cardiovascular risk, reported poor preventive health behaviors, and delayed seeking care for symptoms. This suggested that differences in both prevention and acute care may be contributing to young women’s elevated acute MI mortality, compared to men. They noted that identifying factors that promote better cardiovascular knowledge, improved preventive healthcare, and prompt care-seeking behaviors are important factors for decreasing mortality among these women.
According to the American Congress of Obstetricians and Gynecologists, approximately 35% of all heart attacks in women go unnoticed or unreported, partly because women’s symptoms are sometimes different from men’s. Many women experience nausea as their primary symptom, along with chest discomfort. Women should also be alert to heartburn that doesn’t go away with antacids or other prescribed medicine.
Signs of a heart attack in women include:
- Discomfort in the chest that usually lasts more than a few minutes or goes away and comes back; it may feel like uncomfortable pressure, squeezing, fullness, or pain.
- Upper body discomfort in one or both arms, the back, neck, jaw, or stomach. Shortness of breath.
- Unusual fatigue, weakness, and/or lightheadedness. Nausea/vomiting, cold sweats, and/or dizziness.
If you experience the above symptoms:
- Minutes matter! Call 9-1-1 for help within five minutes if you think you may be having a heart attack.
- Do not drive yourself or anyone else with symptoms to the hospital, unless you have absolutely no other option.
- While you are waiting for the ambulance to arrive, chew a regular (325 milligram) aspirin, lie down, and breathe slowly, all of which may help limit the damage to your heart.
The study authors are affiliated with: Yale School of Public Health, New Haven, CT; Northwestern University Feinberg School of Medicine, Chicago, IL; Saint Luke’s Mid America Heart Institute, Kansas City, MO; School of Medicine and School of Pharmacy, University of Missouri-Kansas City; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT; Section of Cardiovascular Medicine, Department of Internal Medicine and Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, CT; and Global Health Leadership Institute, Yale University, New Haven, CT.