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Women
with Heart Disease: Different Symptoms, Different Mechanisms,
Different Treatment
The
proportion of women among patients presenting with heart
attacks in emergency departments in the U.S. has increased
from 35% in 1975 to 45% in 1995.3
Nonetheless,
the distinctive features of heart disease in women remain
under researched and under appreciated, in part because
the proportion of female patients in clinical investigations
of heart disease has lagged, even relatively recently.
Only 25% of patients in clinical trials for myocardial
infarction, unstable angina, or acute coronary syndromes
published from 1991-2000 were women.3
Women
often experience and report symptoms of myocardial infarction
differently from men.4
For
example, the classic symptoms for men include pressure
in the center of the chest that radiates down the arm
or neck. However, 43% of the women in one study said they
never experienced chest discomfort before their heart
attacks.4
Instead,
the most common symptoms experienced one month before
their AMI were:
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71%
reported unexplained or unusual fatigue |
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48%
sleep disturbance |
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58%
shortness of breath |
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55%
weakness |
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Only
30% experienced chest pain, the hallmark symptom
in men, before the heart attack |
In
addition, women experiencing angina may also have a
higher risk of CVD than their symptom intensity would
suggest.5
Therefore,
female patients complaining of these symptoms can easily
be misdiagnosed in the emergency department and erroneously
sent home, especially if their electrocardiogram appears
normal.6
Based on these findings, it is important for physicians
and women to be aware of the early warning signs so
that they will be more likely to accurately diagnose
an acute myocardial syndrome and to treat the problem
as early as possible.
The causes and risk factors that lead to the development
of various forms of heart disease may also differ between
women and men. For example, in analyzing the factors
that contribute to heart failure, high blood pressure
and diabetes appear to be more important among women
than among men, while coronary artery disease is a more
important factor among men.7
Even when heart disease is correctly assessed, women
often face gender-based differences in treatment. Women
are less likely than men to receive aggressive treatment
for heart attack, such as angioplasty or bypass surgery,
and are more likely to die in the hospital; these gender
differences are similar regardless of heart attack severity.8
Black
women are even less likely to be treated aggressively.9
References
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