AIM: Chest pain more common indication of ACS in women

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Chest pain is still the most common sign of a heart attack for most women, although studies have shown that women are more likely than men to have symptoms other than chest pain or discomfort when experiencing a heart attack or other form of acute coronary syndrome (ACS), according to an study published online Dec. 10 in the Archives of Internal Medicine.

John G. Canto, MD, of the Watson Clinic in Lakeland, Fla., and colleagues, examined 35 years of research that yielded 69 studies and found that, depending on the size of the study (which ranged from large trials to single centers and interviews), between 30 percent and 37 percent of women did not have chest discomfort during a heart attack. In contrast, 17 percent to 27 percent of men did not experience chest discomfort. Overall, the majority of women and men in the reviewed studies had chest discomfort with heart attack (two-thirds to three-quarters, depending on study size).

The authors also found that older people are more likely to have heart attack without chest discomfort. However, because women are on average nearly a decade older than men at the time of their initial heart attack, the researchers call for more studies to determine the degree to which gender independently influences heart attack symptoms.

They concluded that current research does not indicate a need to differentiate heart attack symptoms in women from those in men, and public health messages should continue to emphasize chest pain or discomfort, shortness of breath, and other common signs of heart attack. Coronary heart disease is the leading cause of death among U.S. women, and affects one in 10 women over the age of 18.
The authors also reported that women are more likely than men to experience other forms of cardiac chest pain syndromes, such as unstable angina, and they appear to report a wider range of symptoms associated with ACS. For example, women are more likely to report pain in the middle or upper back, neck, or jaw; shortness of breath; nausea or vomiting; indigestion; loss of appetite; weakness or fatigue; cough; and dizziness.

National Heart, Lung, and Blood Institute of the National Institutes of Health funded the study.