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Heart attacks and chest pain: Understanding the signs in young women

4357257999_17b19c2770I'll be honest: Though I knew that young people can have heart attacks and the symptoms can be difficult to recognize in women, I'd never given much thought to the topic. But this press release on chest pain and heart attacks in young men and women has gotten me thinking.

A research team led by scientists at the Research Institute of the McGill University Health Centre in Canada found that women under the age of 55 are more likely to have a heart attack without chest pain than men.

Until recently, little was known about the signs of Acute Coronary Syndrome (ACS), a condition that includes heart attack and chest pain, or how these signs may differ between younger men and women. To explore signs of ACS in men and women, the research team studied a group of 1015 patients (approximately 30 percent of them women) under the age of 55 who had been hospitalized for ACS.

The researchers found that chest pain was the most common sign of ACS in men and women, but women were more likely to have ACS with little or no chest pain than men. Patients who had ACS without chest pain tended to report fewer symptoms overall. Yet, chest pain was not associated with the severity of the patient’s ACS.

From the study, which was published online in JAMA Internal Medicine:

Chest pain is the hallmark and critical distinguishing symptom used to initiate diagnostic testing for acute coronary syndrome (ACS) and urgent lifesaving therapy. However, up to 35% of patients with ACS do not report chest pain. These patients are more likely to have a misdiagnosis in the emergency department and a higher risk of death compared with those with chest pain.

The senior author described the significance of these results in the release:

"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 senior author of the study, Dr. Louise Pilote, director of the Division of General Internal Medicine at the MUHC and McGill University and professor of medicine at McGill University.

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."

This study highlights the importance of recognizing that men and women may show signs of heart attack, and other diseases, differently. Since the symptoms of ACS can be misleadingly mild for young women, women should take care to learn how heart attacks present themselves in women, and be sure to speak up if they have these symptoms.

Holly MacCormick is a writing intern in the medical school’s Office of Communication & Public Affairs. She is a graduate student in ecology and evolutionary biology at University of California-Santa Cruz.

Previously: Paper highlights major differences in disease between men and womenThe road to diagnosis: How to be insistent, persistent and consistentAsk Stanford Med: Cardiologist Jennifer Tremmel responds to questions on women’s heart healthA focus on women’s heart healthUnderstanding and preventing women’s heart disease and Gap exists in women’s knowledge of heart disease
Photo by Sebastian Anthony

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