The research, which examined more than 1 million heart attack admissions to hospitals from 1994 to 2006, highlights an important challenge doctors confront: it’s tough to recognize heart attacks in younger women with atypical symptoms -- shortness of breath, extreme fatigue, nausea, or heart palpitations and no chest pain -- but a delay in diagnosis and treatment leads to a greater risk of dying.
“Chest pain is a hallmark symptom of a heart attack but fewer women present with this symptom than men,” said study author Dr. John Canto, a cardiologist at the Lakeland Regional Medical Center in Florida. Nearly 19 percent of women under 45 who had heart attacks had no chest pain in the study compared with 13 percent of men.
But Dr. Stacy Fisher, a cardiologist at the University of Maryland Medical Center who wasn’t involved in the research, said plenty of men in the study also presented without chest pain, and in both genders, the absence of chest pain was associated with a four- to five-fold increase in mortality.
And nearly half of men and women over age 65 who had heart attacks in the study never felt the telltale chest-squeezing tightness with pain radiating down their arm or into their neck and jaw.
The absence of chest pain symptoms appeared to result in a delay in diagnosis and treatment, the study found. Those without chest pain came into the hospital for treatment, on average, about two hours later and were given EKGs to check for signs of a heart attack about 15 minutes later than those with chest pain.
Younger men without chest pain received their first treatment with a clot-busting drug intended to restore blood flow to the heart within an average of 62 minutes after they entered the hospital, compared with an average of 81 minutes for younger women without chest pain.
“These delays in diagnosis and treatment are huge,” said Dr. Malissa J. Wood, co-director of the Massachusetts General Hospital’s women’s heart health program. “Time equals muscle because muscle deprived of oxygen can be injured or die in the setting of a heart attack.”
