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Heart Attack Symptoms in Women

Chest pain or discomfort has long been regarded as the most common early warning sign of a heart attack for both men and women. However, several recent reports have found that women are more likely to have other symptoms of a heart attack. A new study looked at the available evidence and concluded that chest pain is the most common sign of heart attack for most women.

Coronary heart disease is the leading cause of death among U.S. women. It affects 1 in 10 women over the age of 18. In light of the recent uncertainty about heart attack symptoms in women, a team led by Dr. John G. Canto of the Watson Clinic in Lakeland, Florida, set out to gather and analyze the available evidence. Their review was done in collaboration with NIH's National Heart, Lung and Blood Institute (NHLBI).

The researchers examined 69 studies over 35 years, ranging from large trials to smaller single-center studies and patient interviews. In the December 10, 2007, issue of Archives of Internal Medicine, they reported that, depending on the size of the study, between 30% and 37% of women did not have chest discomfort during a heart attack. In comparison, 17% to 27% of men did not experience chest discomfort.

While the majority of women — two-thirds to three-quarters — had chest discomfort with heart attack, the authors found that women appear to report a wider range of symptoms. Women are more likely to report pain in the middle or upper back, neck or jaw; shortness of breath; nausea or vomiting; indigestion; loss of appetite; weakness or fatigue; cough; dizziness; and palpitations.

The authors uncovered a possible explanation for the gender discrepancy. Older people in general were more likely to have a heart attack without chest discomfort. As women are, on average, nearly a decade older than men at the time of their initial heart attack, this fact may partly account for the finding that fewer women seem to have chest discomfort.

The team concluded that the available evidence does not support the idea that public health messages need to differentiate heart attack symptoms in women and men. They recommend that, for now, health campaigns continue to emphasize increased awareness of chest pain or discomfort, shortness of breath and other common signs of heart attack for both genders.

The researchers don't think the case is closed, however. They noted that many of the studies they looked at excluded patients who didn't report chest pain in the first place. They also pointed out the need for standardized data collection efforts. More studies will be needed to finally settle the issue of how much gender influences heart attack symptoms.

While chest pain may be the most common sign of heart attack for most women, any new symptoms should be promptly evaluated. Surveys suggest that more women are now aware that heart disease is their leading killer, but many still don't take their risk of heart disease personally and seriously.