Last week, an article in the prestigious journal JAMA (Journal of the American Medical Association) made headlines with its finding that women who suffer heart attacks are less likely to have chest pain and more likely to die when compared to male heart attack victims.
Examining more than one million heart attack patients, study authors identified differences between the sexes. But a woman must read between the lines to determine how this study should influence her “heart attack action plan.”
The primary focus of the journal article is chest pain. Overall, 35 percent of heart attack patients did not have chest pain. There was a difference between the sexes, with chest-pain-free heart attacks occurring in 31 percent of men and 42 percent of women. But don’t let this relatively small difference obscure the most important point.
Chest pain is the cardinal sign of heart attack in both men and women. The majority of heart attack victims do have chest pain.
The action plan is clear. If you have chest pain that lasts for more than a few minutes, call 911. You could be having a heart attack.
Other heart attack symptoms
How can you tell if you are having a heart attack but don’t have chest pain? This can be challenging, even for doctors. But with a little detective work, we can help you figure things out.
Other common heart attack symptoms include shortness of breath, weakness, fatigue, cold sweats, dizziness, nausea, indigestion, and back pain. If these symptoms begin with no apparent reason (e.g., you feel like you have indigestion but you have not eaten recently, or you are experiencing shortness of breath that feels out of the ordinary for you) and don’t resolve within a few minutes, call 911.
The JAMA article points out another key issue with heart attacks in women— delays. Women wait longer than men before seeking treatment for a heart attack, particularly if they don’t have chest pain.
Other studies suggest that when women do seek help, they are more likely to go to a doctor’s office instead of heading straight to the emergency room. Once they finally reach the emergency room, they often face greater delays in diagnosis than do men. Meanwhile, as the minutes tick by, muscle cells are dying and heart function is deteriorating. Rapid treatment is the key to rescuing the heart from the damaging effects of a heart attack.
Do women fare worse?
In general, the answer is “yes.” Women who suffer heart attacks are more likely to die than are men who suffer heart attacks, and the new paper in JAMA supports this with the finding that about 15 percent of women died vs. only 10 percent of men.
Trying to explain this discrepancy, other studies point to the higher risk profile of the average female patient. On average, female heart attack patients are five to 10 years older than male heart attack victims and tend to have more serious health problems, including diabetes, high blood pressure and heart failure. These additional health issues explain most of the outcome differences between women and men.
The problem of younger women
Younger women— less than 55 years old— deserve special attention. While heart attacks are not particularly common in this age group, they are devastating when they occur. In the JAMA study, young women did worse than similarly aged men, whether they had chest pain or not.
Some scientists believe that younger women have unusually aggressive coronary heart disease, insofar as it is able to overcome the protective effect of circulating estrogen. Compounding these issues, young women are also more likely to experience delays in treatment, either because they do not go to the hospital or because doctors miss the diagnosis. But we are making progress. Other studies show that over the last ten years, outcomes after heart attack have improved among young women.
What you can do
1.) Do not ignore chest pain— call 911 if it lasts more than a few minutes.
2.) Be suspicious of shortness of breath, fatigue, nausea or indigestion (particularly if they come on for no apparent reason).
3.) Don’t delay calling 911— delays are deadly.
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