Silent & atypical heart attacks more dangerous & fatal in young women

It is known that chest pain or discomfort is the most common heart attack symptom. In addition, fatigue, nausea, shortness of breath and pain or numbness in the jaw, arms or back can also signal a blocked artery cutting off vital oxygen and nutrients from the heart.

A new study of more than 1 million heart attack patients however reveals that women under 55 are less likely to seek medical attention for those atypical symptoms and more likely to die in a hospital from a heart attack than men of the same age.

“Young women who have atypical symptoms might not appreciate that they're in fact having a heart attack and may be more likely to delay treatment,” said Dr. John Canto, a cardiologist at the Watson Clinic in Lakeland, Fla., and lead author of the study published today in the Journal of the American Medical Association. “They think it's the flu or stress or a pinched nerve, and they don't want to come in to the hospital only to have doctors tell them it's nothing serious. But we should all err on the side of caution.”

Canto and his colleagues analyzed medical records in a national database of heart attack patients from 1994 to 2006, including about 1.1 million people treated at close to 2,000 hospitals. They found that 31 percent of male patients didn't have any chest pain or discomfort, compared to 42 percent of women.

Women under 45 were 30 percent more likely than men in their age group to present without chest pain; between ages 45 and 65 the difference dropped to around 25 percent, and after 75, it all but disappeared. A similar pattern, with smaller differences between sexes, was seen in the likelihood of death.

Almost 15 percent of women died in the hospital after their heart attack, compared to about 10 percent of men. Younger women with no chest pain were almost 20 percent more likely to die than male counterparts. But after age 65, the women's risk fell below that of men.

“Less than 20 percent of patients who present to a hospital with typical or atypical symptoms are in fact having a heart attack,” said Canto. “But time is muscle and muscle is life. When an artery is blocked, the heart muscle begins to die after 30 to 60 minutes. We call it the golden hour of heart attacks. Every minute you wait after that golden hour, more heart muscle will die. And once you lose it, it's not coming back.”

Dr. Patrick O'Malley, an internist at the Uniformed Services University of the Health Sciences in Bethesda, Maryland, said at least part of that difference could be due to lack of action by patients and doctors when symptoms are unusual. “We tend to not think of heart disease in younger women if they're not having chest pain... and therefore we're not going to be as aggressive,” he said. “It does delay treatment.” For patients, “because it's not chest pain, they'll be coming later,” added O'Malley, who didn't participate in the new research.

Dr. Malissa Wood, spokeswoman for the American Heart Association and co-director of Massachusetts General Hospital's Corrigan Women's Heart Health Program, said women tend to look out for the hearts of others more so than their own. “I think women tend to worry so much about breast cancer, and I understand why,” said Wood, who has survived breast cancer herself. “But heart disease is the No. 1 killer of women.” Women should “know their numbers” and risk factors, said Wood. Smoking, high blood pressure, high cholesterol, diabetes and a family history of heart disease raise the risk of heart attack. “The more risk factors you have, the more you really need to pay attention when symptoms strike out of the blue,” she said. “It's rare for young women to have a heart attack, but the results can be devastating.”

The study actually may underestimate the gender gap, because many female heart attacks never make it to the hospital, says Cam Patterson, chief of cardiology at the University of North Carolina-Chapel Hill, who was not involved in the study. According to the Centers for Disease Control and Prevention, close to 800,000 Americans have their first heart attack every year, and heart disease is the leading cause of death for both men and women.

Although the results are based on a study of more than a million heart attack patients, Canto cautioned, they are still preliminary. “If our results are in fact true, I would argue that rather than the one-size-fits-all symptom message, we also have to tailor that message to say that women less than 55 are also at higher risk for atypical presentation,” which includes jaw or arm pain, Canto told Reuters Health.

The registry used in the new study was funded by Genentech, and some of the authors report financial partnerships with pharmaceutical companies.

Dr. Ananya Mandal

Written by

Dr. Ananya Mandal

Dr. Ananya Mandal is a doctor by profession, lecturer by vocation and a medical writer by passion. She specialized in Clinical Pharmacology after her bachelor's (MBBS). For her, health communication is not just writing complicated reviews for professionals but making medical knowledge understandable and available to the general public as well.

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