Women With Heart Attack Do Present With Typical Symptoms

Typical symptoms of myocardial infarction are more common and have greater predictive value in women than in men, according to a study published in the issue of the Journal of the American Heart Association.

Amy V. Ferry, from the University of Edinburgh in the United Kingdom, and colleagues evaluated patient-reported symptoms in 1,941 patients (39 percent women) presenting to the emergency department with suspected acute coronary syndrome. Typical and atypical presentations were characterized based on pain nature, location, radiation, and additional symptoms, while a diagnosis of myocardial infarction was determined using a high-sensitivity cardiac troponin I assay with sex-specific thresholds.

The researchers found that type 1 myocardial infarction was diagnosed in 16 percent of men (184 of 1,185) and 12 percent of women (90 of 756). Five percent of men and 30 percent of women were reclassified using the high-sensitivity cardiac troponin I assay. Chest pain was the most common presenting symptom (91 percent of men and 92 percent of women). Typical symptom presentation was more common in women with myocardial infarction (77 percent; 69 of 90) than in men (59 percent; 109 of 184). There was an association between the presence of at least three typical features and a positive likelihood ratio (PLR) for the diagnosis of myocardial infarction in women (PLR, 1.18; 95 percent confidence interval, 1.03 to 1.31), but not in men (PLR, 1.09; 95 percent confidence interval, 0.96 to 1.24).

"Our concern is that by incorrectly labeling women as having atypical symptoms, we may be encouraging doctors and nurses not to investigate or start treatment for coronary heart disease in women," Ferry said in a statement. "Both men and women present with an array of symptoms, but our study shows that so-called typical symptoms in women should always be seen as a red flag for a potential heart attack."

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