For Many Women, No Elephant Sitting On Their Chest' With MI

Chest pain may be the characteristic symptom of myocardial infarction, but it doesn’t occur in a significant percentage of patients, especially younger women. A result is a higher in-hospital mortality rate for women compared to men, especially at younger ages. What does this mean for how MI should be identified in your ED?

More than one-third of all patients and 42% of women with myocardial infarction (MI) present to the ED without acute chest pain or discomfort—and they have nearly twice the short-term mortality rate of those with the hallmark symptom, according to a recent study in JAMA. Women under the age of 45 are 30% more likely to have an atypical presentation than men of the same age, but the difference largely disappears by age 75. Overall, the mortality rate for women admitted to the hospital with MI was 14.6% compared to 10.3% for men.

Researchers wrote that young women experiencing MI without chest pain tend to delay seeking treatment and, once they do present to the ED, they are often treated less aggressively because of their age and atypical symptoms. In a related blog, lead researcher John G. Canto, MD, MSPH, director of cardiovascular cardiovascular prevention research and education at the Watson Clinic and director of Lakeland Regional Medical Center’s chest pain center in Lakeland, FL, advises ED physicians to consider other presentations as possible signs of a heart attack in young women, including “pain or discomfort in areas other than the chest, like the jaw, neck, shoulder, arms, and stomach,” as well as shortness of breath. For these patients, objective screening with an ECG and blood tests to assess cardiac biomarkers may identify a larger proportion of young women with MI and improve survival rates.

The American Heart Association says many women attribute MI symptoms to the flu or acid reflux. They are more likely to present with extreme fatigue, nausea, pressure or pain in the abdomen, upper back pressure, dizziness, lightheadedness, or fainting. Considering these symptoms during evaluation as possible signs of MI can lead to quicker, more appropriate treatment.

The study looked at the data from 1,143,513 records taken from the National Registry of Myocardial Infarction from 1994 to 2006.

View other topics in this week's edition of Pertinent Practice Pearls (free for everyone):

• Toothaches Create New World of Pain for EDs
• Find Out When to Trust Rapid Flu Tests
• Opioid Prescriptions from ED Less Likely to Result in Fatalities

View related topics in EB Medicine's publications (free for subscribers):

• Low-Risk Chest Pain In The Emergency Department: Current Guidelines
• The Diagnosis And Treatment Of STEMI In The Emergency Department