Heart attack symptoms often misinterpreted in younger women

According to a YSPH study, younger women are more likely to mistake heart attack symptoms for anxiety or stress, and more likely to be misdiagnosed by a doctor.
A black and white photo of a woman clutching her chest, with the area of the heart highlighted in red.

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Young women who report heart attack symptoms are more likely to have them dismissed by their providers as not heart related, a new study led by the Yale School of Public Health (YSPH) finds.

The research, published in Circulation, a journal of the American Heart Association, examined the relationship between gender, self-reported symptoms, perception of symptoms, and self-reported care-seeking among patients 55 years and younger who were hospitalized for acute myocardial infarction (AMI). The differences in AMI symptom presentation by gender have been studied in older populations, but less is known about young patients with AMI.

Analysis of data from 2,009 women and 976 men collected from more than 100 hospitals showed that the majority of both men and women reported chest pain, pressure, tightness, or discomfort as their main AMI symptom. Yet women were more likely than men to report other associated symptoms of heart attack, such as indigestion, shortness of breath, palpitations, or pain in the jaw, neck, or arms. Women were also more likely to perceive their symptoms as stress or anxiety, and were more likely than men to report that their healthcare providers did not think that their symptoms were heart-related, the researchers said.

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,” said lead author Judith H. Lichtman, associate professor and chair of the Department of Chronic Disease Epidemiology at YSPH.

Previous studies have reported that women are less likely to present with chest pain for AMI, more likely to report a wider variety of symptoms, and also more likely to die in hospital from AMI.

The study results, as well as the increased mortality associated with AMI in younger women, indicate the need to further investigate the variety of acute symptoms of heart disease in younger patients, and the need to explore how symptom recognition influences patients’ care-seeking behaviors and early interactions with health care providers, said the researchers.

An important point is that these young women all had multiple cardiac risk factors prior to their AMI, said Gail D’Onofrio, M.D., co-author of the study and 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.” 

The study used data from Yale’s Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) study. VIRGO was conducted by a multidisciplinary research team from the Yale School of Medicine in collaboration with investigators from other institutions, and addressed questions ranging from genetics to clinical care and outcomes. The study was funded by the National Heart Lung and Blood Institute of the National Institutes of Health.

Other Yale authors of the study are Erica Leifheit, Ph.D.; Basmah Safdar, M.D.; Haikun Bao, Ph.D.; Nancy Lorenze, D.N.Sc.; and Harlan Krumholz, M.D.


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Michael Greenwood: michael.greenwood@yale.edu, 203-737-5151