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AMI in Young Women Usually Presents With Chest Pain, Other Symptoms

Despite conventional wisdom that young women with acute myocardial infarction (AMI) present with an entirely different set of complaints than young men, a new study found that chest pain was the predominant symptom for both sexes.

Other factors differed by sex, however, according to the article in Circulation.

Yale University-led researchers determined that women with AMI, whether or not they had chest pain, were more likely to report a wide range of symptoms. In addition, clinicians were less likely to diagnose their symptoms as heart disease, compared with men.

“Although chest pain was the most common symptom for young women and men, the presentation of chest pain within the context of multiple symptoms may influence the prompt recognition of heart disease for these young patients,” explains lead author Judith H. Lichtman, PhD, MPH, associate professor and chair of the Yale School of Public Health’s Department of Chronic Disease Epidemiology.

To determine how young heart attack patients present with symptoms, how they perceive those symptoms, and how they seek care, the study team interviewed 2,009 women and 976 men 18 to 55 years old who were hospitalized for AMI at 103 US hospitals as part of the Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) study.

Based on the structured patient interviews during the initial AMI hospitalization, the researchers compared patient characteristics and presentation information by sex.

Results indicate that 87% of women and 89.5% of men presented with chest pain, which was defined as pressure, tightness, or discomfort. Women, however, were more likely than men to present with three or more associated symptoms — 61.9% of women vs. 54.8% of men. Other complaints included epigastric symptoms, palpitations, and pain or discomfort in the jaw, neck, or arms, or between the shoulder blades.

Furthermore, the study found in adjusted analyses that women with an ST-segment elevation AMI were more likely than men to present without chest pain, for an odds ratio of 1.51. Female AMI patients also were more likely to attribute their symptoms to stress or anxiety than males — 20.9% vs. 11.8% — but less likely to blame muscle pain — 15.4% vs. 21.2%.

Study authors point out that nearly 30% of women and slightly more than 22% of men had sought medical care for similar symptoms before they were diagnosed and hospitalized. However, many more women than men — 53% compared to 37% — reported that their healthcare provider did not attribute the symptoms to cardiovascular issues.

“An important point is that these young women all had multiple cardiac risk factors prior to their AMI,” notes co-author Gail D’Onofrio, MD, chair of the Department of Emergency Medicine at Yale School of Medicine. “Thus, when young women with multiple risk factors visit their doctor with any chest discomfort or other symptoms that may be associated with ischemic heart disease, they should have the appropriate work-up.”