Don't overlook MIs in middle-aged women

Do you triage female patients differently than males? According to a recent study, ED nurses fail to associate symptoms of middle-aged women with myocardial infarction (MI), which may contribute to increased morbidity and mortality in those patients.1

During focus groups, nurses admitted they were less likely to suspect MI in middle-aged women, and admitted that MI wasn’t the first diagnosis considered for middle-aged women, even if the patients had symptoms consistent with MI.

Equal-opportunity events’

Women are less likely than men to be diagnosed with an MI, receive early or aggressive treatment, and are more likely than men to die of an MI, notes Mary M. Hand, MSPH, RN, coordinator of the National Heart Attack Alert Program in Bethesda, MD. "Heart attacks are equal-opportunity events when it comes to men and women," she says.

Here are ways to ensure that MIs are not overlooked:

Address personal concerns.

Overlooking the risks of women having a heart attack might reflect your own fears, Hand suggests. "Many nurses are women, so they may fall prey to the myth that women are not as likely as men to have a heart attack," she says.

Have a high index of suspicion.

You can play a key role in identifying women who are potential heart attack patients quickly by having a high index of suspicion for the following patient complaints:

— shortness of breath;

— indigestion;

— jaw, neck, arm, back, or shoulder pain;

— breaking out into a cold sweat;

— feeling lightheadedness.

If you suspect a heart attack, get a 12-lead ECG promptly, urges Hand.

"Ensure that appropriate treatment, including reperfusion therapy if indicated, is delivered in a timely manner," Hand says. A timely manner means within 30 minutes after arrival for thrombolytic therapy, and a maximum of 120 minutes for balloon-to-inflation where percutaneous transluminal coronary intervention is available.2

Know the facts about risk.

Always keep in mind that heart attack is the No. 1 cause of death in women, Hand advises. "We know from surveys that many women don’t know this. For example, they often cite breast cancer as the leading cause of death," she says.


1. Arslanian-Engoren C. Gender and age bias in triage decisions. J Emerg Nurs 2000; 26:117-124.

2. Cannon C. Relationship of symptom onset-to-balloon time and door-to-balloon time with mortality in patients undergoing angioplasty for acute myocardial infarction. JAMA 2000; 283:2,887-3,030.