Heart Attack Pain Similar for Men and Women - NYTimes.com

Heart Attack Pain Similar for Men and Women

By RONI CARYN RABIN

Women are more likely than men to die after a heart attack, and some researchers have suggested a reason: Doctors may be misdiagnosing women more often because their symptoms differ from those experienced by men.

But a study published Monday indicates that too much has been made of gender differences in chest pain, the hallmark symptom of heart disease. Although the researchers found some distinctions, no pattern was clearly more characteristic of women or could be used to improve heart attack diagnosis in women, the authors concluded.

“We should stop treating women differently at the emergency room when they present with chest pain and discomfort,” said Dr. Maria Rubini Gimenez, a cardiologist at University Hospital Basel and lead author of the new study, published in JAMA Internal Medicine.

Instead, she said, all patients with acute chest pain must be evaluated for heart attack with appropriate diagnostics, including an electrocardiogram and blood tests.

Roughly 80 percent of people who have chest pain and discomfort are suffering from indigestion, acid reflux or another relatively benign condition, said Dr. John G. Canto, director of the chest pain center at Lakeland Regional Medical Center in Lakeland, Fla., who has researched heart attack diagnosis.

“The trick is, how do you figure out the 15 to 20 percent actually having a heart attack?” he said. The new research confirms “that there is a lot of overlap in symptoms between patients who are having a heart attack and those who aren’t, and there is a lot of overlap in symptoms between men and women.”

The new study examined 2,475 patients, including 796 women, who reported to emergency rooms at nine hospitals in Switzerland, Spain and Italy complaining of acute chest pain between April 21, 2006, and Aug. 12, 2012.

The conventional wisdom is that men experience often crushing chest pain during a heart attack, while women may complain of pressure or pain in the lower chest or abdomen, which may spread to the shoulders or arms.

In the study, doctors and nurses asked the patients to describe their pain, using a detailed form listing 34 characteristics. Was the pain a stabbing pain, a burning pain, or more like pressure? Where was it located — in the middle of the chest, or to one side? Did it radiate outward to one of the shoulders or to the abdomen? How long did it last?

About one in five patients was diagnosed with a heart attack, including 143, or 18 percent, of the women and 369, or 22 percent, of the men. The vast majority of heart attack patients — some 92 percent — complained of chest pain or discomfort, and for the most part there were no dramatic differences in the types of chest pain experienced by men and women.

There were gender differences in only three of the 34 characteristics, researchers found.

Pain duration of less than 30 minutes was less likely to signify a heart attack in women and more likely to indicate one in men. Pain lasting more than 30 minutes was more likely to indicate a heart attack in women but was not indicative in men. And a decreasing intensity of pain suggested that a woman was not having heart attack, while indicating that a man might be.

Though these differences were statistically significant, they were not consistent enough to be used to determine whether a woman was having a heart attack or suffering another ailment, the researchers said.

via Heart Attack Pain Similar for Men and Women - NYTimes.com.