According to the study Men and women facing an AMI, do we act differently? , “ only one in four women recognizes the symptoms of acute myocardial infarction, while the rest confuse them with digestive or respiratory problems or anxiety-depressive disorders”.
This leads us to the following statement from the study: “women took an average of 237 minutes to get to the ER from the onset of pain, compared to 98 minutes for men” . Almost three more hours!
It could be said that this is catastrophic if we take into account that acute myocardial infarction is a time-dependent pathology. Failure to recognize heart attack symptoms in women causes delays in seeking treatment and increases sequelae and mortality rates.
This is why different associations and medical societies have been trying for years to train the population and health professionals in the recognition of specific symptoms.
In Europe a woman dies from cardiovascular disease every 6 minutes
For example, the “ Go red for women “ initiatives of the American Heart Association and the ” Women for the heart “ initiative of the Spanish Heart Foundation emphasize two important messages : “the symptoms of a heart attack in women may be different than in men. men and cardiovascular diseases are not just a men’s thing” .
According to the Spanish Society of Cardiology, in its report Cardiovascular disease in women. Study of the situation in Spain: ” cardiovascular disease is the leading cause of death in women, similar to the rest of the Western world: in Europe one death occurs for this reason every 6 minutes “.
How does the body warn you before having a heart attack?
The main reason for this difference between men and women is that chest pain caused by a heart attack has been explained both to the population and to health professionals always in the same way, the way in which this pain occurs in men: chest pain with pressure and that pain goes to the left arm . This is due, as indicated in the aforementioned SEC report, to the fact that “most of the information we handle on cardiovascular disease in women comes from registries and studies where women make up less than 30% of the population analyzed”.
This higher proportion of men in the studies has led the American Heart Association to draw up a decalogue with the priorities to improve outcomes in women with heart attacks. Point number one is the one addressed in this article: to increase the awareness of women, health personnel, the public and policy makers about the risk of acute myocardial infarction, the specific symptoms associated with sex and the clinical presentation .
The VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study, the PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) study, and the YOUNG-MI study all agree, stating that “men and Women younger than 55 are just as likely to have chest pain, but women are more likely to have other associated symptoms.”
How does a heart attack manifest in women?
The “usual” chest pain associated with a heart attack is a squeezing pain in the center of the chest that radiates to the left arm (the right arm can also hurt). But those associated symptoms that women have, according to multiple studies and the Spanish Heart Foundation are:
- Uncomfortable chest pressure or pain in the center of the chest. It may last a few minutes, or it may go away and come back.
- Pain in one or both arms, back, neck, jaw, or stomach.
- Shortness of breath, accompanied or not by chest pain.
- Other signs such as cold sweat, nausea or dizziness.
- Tiredness, generalized weakness.
As in men, the most common heart attack symptom among women is chest pain or discomfort. The difference is that women are more likely to experience other common symptoms, particularly shortness of breath, nausea, vomiting, and back or jaw pain.
In addition to the symptoms, other factors come into play in a heart attack in women
In addition to differences in symptoms, there are other factors that make it difficult to manage and diagnose heart attacks in women. Men and women have different risk factors, genetic factors, hormonal cycle, pain perception threshold, environmental and psychosocial factors.
The WISE (Women and cardiovascular heart disease: Clinical implications from the Women’s Ischemia Syndrome Evaluation) study was the first large study to look at all of these factors. All are currently under study to improve knowledge of the pathology and pathophysiology of the differences in ischemic heart disease and infarction between men and women.
Until the results of these studies and the work of scientific societies leave their mark, the most important thing for the population is the recognition of these symptoms of heart attack in women . If you suspect these symptoms at any time, do not hesitate to consult your doctor or healthcare professional.
Bibliographic references
Mehta et al. 2016. Acute Myocardial Infarction in Women. Scientific Statement From the American Heart Association. Circulation. DOI: 1161/CIR.0000000000000351.
Bairey et al. 2006. Insights from the NHLBI-sponsored Women’s Ischemia Syndrome Evaluation (WISE) study. Part II: Gender differences in presentation, diagnosis, and outcome with regard to gender-based pathophysiology of atherosclerosis and macrovascular and microvascular coronary disease. J Am Coll Cardiol. DOI: 1016/j.jacc.2004.12.084.
Fradejas et al. 2017. Men and women before an ACUTE MYOCARDIAL INFARCTION. do we act different? Rev Esp Cardiol. Available at: https://www.revespcardiol.org/en-congresos-sec-2017-el-congreso-51-sesion-papel-enfermeria-rehabilitacion-cardiaca-arritmias-3274-varones-mujeres-ante-un-infarto -37314
Report of the Government of Spain. Anguita et al. 2008. Cardiovascular disease in women. Study of the situation in Spain. Spanish Society of Cardiology. Available at: https://www.sanidad.gob.es/eu/organizacion/sns/planCalidadSNS/docs/enfCardiovascMujerEspana.pdf
Arora et al. 2019. Twenty Year Trends and Sex Differences in Young Adults Hospitalized With Acute Myocardial Infarction. Circulation. DOI: https://doi.org/10.1161/CIRCULATIONAHA.118.037137
