Chest pain is highly recognizable as a symptom of heart problems. But new research suggests that one in five women aged 55 or under will not experience chest pain as a symptom of heart attack.
Scientists from the Research Institute of the McGill University Health Centre (RI-MUHC) say this finding has serious implications for healthcare professionals when it comes to accurately diagnosing and treating heart attack.
They add that as many as 35% of patients with acute coronary syndrome (ACS) do not report experiencing chest pain.
This means that they are more likely to be misdiagnosed in the emergency department and have an increased risk of death, compared with patients who do experience chest pain.
For this study, published in JAMA Internal Medicine, the researchers analyzed 1,015 patients who had been hospitalized as a result of ACS. Of the patients, 30% were women aged 55 or under.
Results of the analysis revealed that chest pain was a presentation symptom of ACS in 80% of all patients. However, this symptom was significantly lower in women, with 13.7% reporting chest pain, compared with 19% of men.
Furthermore, young women who experienced no chest pain also had fewer symptoms in general, compared with women who had chest pain.
The most common non-chest pain symptoms in both sexes were weakness, shortness of breath, feeling hot, cold sweat, and pain in the left arm or shoulder.
The findings showed, however, that the majority of women without chest pain had more “non-chest pain” symptoms, compared with men without chest pain.
The researchers note that although patients without chest pain had fewer symptoms overall, their ACS was no less severe. This meant ACS could only be diagnosed by detailed cardiological assessments.
Dr. Louise Pilote, director of the Division of General Internal Medicine at the MUHC and professor of medicine at McGill University, says:
“We need to move away from the image of an older man clutching his chest when we think about acute coronary syndrome. The reality is that chest pain, age and gender are no longer the definers of a heart attack.”
Dr. Pilote continues:
“Our study demonstrates that young people and women who come into the emergency room 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.”
The researchers note that the reasons why there are sex differences in ACS symptoms are not clear, but that these findings should trigger awareness in healthcare providers.
“Our findings indicate that chest pain is the predominant symptom that should direct diagnostic evaluation for ACS and be used for public health messages for young women and men similar to older patients,” they add.
“However, health care providers should still maintain a high degree of suspicion for ACS in young patients, particularly women, given that 1 in 5 women with diagnosed ACS do not report with chest pain.”