Heart Attack

Heart Attack Signs Go Unrecognized in Young Women

One might think a thirty-something woman has a better chance of getting attention in a crowded emergency room than her parent or grandparent, but new research suggests she might actually fare worse at the hospital.

In a recent study out of the Cardiac and Vascular Institute at NYU Langone Medical Center in New York City, researchers concluded female patients who show signs of heart attack receive lower quality of care and experience worse outcomes compared to men, primarily women younger than 35.

The researchers looked at records from 369 hospitals across the United States, says Sripal Bangalore, MD, an assistant professor in the Department of Medicine, cardiology division, at NYU Langone Medical Center, who led the study. They noted quality metrics and in-hospital death rates for heart attack patients, and grouped them by gender and age.

"For both younger women and older women, the in-hospital death rate was higher compared to their male counterparts," Dr. Bangalore says. When comparing the women older than 45 to younger women, however, the researchers found patients in the younger group died in-hospital at a strikingly higher rate.
Recognizing Heart Attacks in Women

There are two aspects to this heightened risk, says Bangalore:

Doctors are trained to think in terms of probability the patient is having a heart attack, so in younger patients, especially women, it might not be their first guess.
Women, unaware they're having a heart attack, may wait longer to call 911, and therefore have worse outcomes when they finally make it to the hospital.

While pressure, tightness, and squeezing in the chest are all telltale signs of heart attack in men, many women don't know they could have a heart attack without having any of those symptoms. A woman having a heart attack might instead feel more subtle hints — like nausea, back and jaw pain, and shortness of breath — in addition to chest pain. These atypical symptoms make recognition tricky for patients and doctors alike.

"If there's a typical patient, a man, of certain age with typical risk factors, it's easy to recognize that these people are at increased risk of a heart attack, and quickly screen and take care of those patients," Bangalore says. He explains that, according to guidelines in the United States, a patient who comes in with chest pain should receive an electrocardiogram (EKG) within five to 10 minutes. For a person presenting without typical symptoms, however, the test might not happen within that time frame.

These findings highlight the need to treat female patients as aggressively as male patients, says Bangalore. That means looking for those atypical symptoms, even in younger women. It's also a message to women: Know the signs of a heart attack and if you suspect something is wrong — don't wait until tomorrow.