"Women less than 55 years old are more likely to have their ACS misdiagnosed in the ER than men, and they have higher risk of death," says Nadia Khan. "The public and physicians need to be aware of this problem." (Credit: Gabriela Pinto/Flickr)

Heart attack: 1 in 5 young women have no chest pain

Chest pain is readily recognized as a symptom of heart trouble, but not all women under the age of 55 experience this pain during a heart attack.

The findings from a recent study are the first to document this phenomenon in young women. As seconds matter when it comes to the accurate diagnosis and treatment of heart attack, the study, published in JAMA Internal Medicine, has implications for emergency room healthcare professionals and for at-risk individuals.

“We need to move away from the image of an older man clutching his chest when we think about acute coronary syndrome (ACS—the umbrella term referring to heart attacks and angina),” says Louise Pilote, director of the Division of General Internal Medicine at the McGill University Health Centre and the study’s senior author.

“The reality is that chest pain, age, and gender are no longer the definers of a heart attack. Our study demonstrates that young people and women who come into the emergency without chest pain, but other telltale ACS symptoms such as weakness, shortness of breath, and/or rapid heartbeats, are in crisis. We need to be able to recognize this and adapt to new standard assessments in previously unrecognized groups such as young women.”

“Women less than 55 years old are more likely to have their ACS misdiagnosed in the ER than men, and they have higher risk of death,” adds first author Nadia Khan, associate professor of medicine at the University of British Columbia. “The public and physicians need to be aware of this problem.”

Pain is not the only indicator

Pilote, Khan, and their colleagues evaluated more than 1,000 young patients who were hospitalized for ACS. Their findings showed that women were less likely to experience chest pain compared with men and that the absence of this pain did not correlate with less severe heart attacks. Patients without chest pain had fewer symptoms overall but their ACS was not less severe. The diagnosis of ACS, therefore, depended on detailed cardiological assessments.

“It is important to remember that chest pain is a main indicator of ACS, but not the only one,” says Pilote.

“We need to remind ourselves that even without chest pain, something serious could still be happening,” adds Khan.

The Heart and Stroke Foundation and the Canadian Institutes of Health Research funded the study.

Source: McGill University

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