Heart Attack Signs Go Unrecognized in Young Women

As nurse practitioners, we are well aware of the need for prompt diagnosis and treatment in patients presenting with chest pain.  Our concern for myocardial infarction increases significantly in patients who are elderly, overweight or have multiple chronic medical conditions.  But, are we overlooking patients who do not fit this profile misdiagnosing younger patients presenting with symptoms of heart attack?

A recent study out of NYU concluded that female patients presenting with symptoms of heart attack receive lower quality of care and experience worse outcomes compared to men, especially women under the age of 35.  Dr. Bangalore, leader of this study states that "for both younger and older women, the in-hospital death rate was higher compared to their male counterparts".  Researchers also found that when comparing women over the age of 45 to younger women, younger women die at a much higher rate. 

Dr. Bangalore feels that this can be attributed to two factors.  First, healthcare providers think in terms of probability when patients present with symptoms of heart attack.  In younger patients, myocardial infarction may not be the diagnosis they suspect in younger women.  Secondly, young women may wait longer to seek medical treatment and therefore experience poor outcomes.

What is the takeaway from this study for you as a nurse practitioner in treating patients who present with symptoms of heart attack?  All patients presenting with chest pain must have an EKG within five to ten minutes of arrival to the hospital or clinic where you work.  Follow this guideline even in patients who do not present with typical symptoms.  Women often present with atypical symptoms of heart attack including dizziness, upper abdominal pain and fainting.  Consider the possibility of heart attack in all patients with these symptoms.  If you work in an outpatient clinic, direct these patients to the emergency room for prompt evaluation. Finally, educate your young female patients about the risk of heart attack as well as the atypical symptoms many women develop during a heart attack.  Instruct them to go to the emergency room immediately if they experience these symptoms.