Women’s Early Warning Symptoms of Acute Myocardial Infarction

Abstract

Background-Data remain sparse on women's prodromal symptoms before acute myocardial infarction (AMI). This study describes prodromal and AMI symptoms in women. Methods and Results-Participants were 515 women diagnosed with AMI from 5 sites. Using the McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey, we surveyed them 4 to 6 months after discharge, asking about symptoms, comorbidities, and demographic characteristics. Women were predominantly white (93%), high school educated (54.8%), and older (mean age, 66Ϯ12), with 95% (nϭ489) reporting prodromal symptoms. The most frequent prodromal symptoms experienced more than 1 month before AMI were unusual fatigue (70.7%), sleep disturbance (47.8%), and shortness of breath (42.1%). Only 29.7% reported chest discomfort, a hallmark symptom in men. The most frequent acute symptoms were shortness of breath (57.9%), weakness (54.8%), and fatigue (42.9%). Acute chest pain was absent in 43%. Women had more acute (mean, 7.3Ϯ4.8; range, 0 to 29) than prodromal (mean, 5.71Ϯ4.36; range, 0 to 25) symptoms. The average prodromal score, symptom weighted by frequency and intensity, was 58.5Ϯ52.7, whereas the average acute score, symptom weighted by intensity, was 16.5Ϯ12.1. These 2 scores were correlated (rϭ0.61, PϽ0.001). Women with more prodromal symptoms experienced more acute symptoms. After controlling for risk factors, prodromal scores accounted for 33.2% of acute symptomatology. Conclusions-Most women have prodromal symptoms before AMI. It remains unknown whether prodromal symptoms are predictive of future events.

Gender and sex: issues in medical education

“…In diagnosing angina pectoris in women, therefore, physicians must be aware of gender differences in symptom presentation as women present typical angina pectoris complaints less frequently. First of all, angina pectoris in women either does not involve chest pain at all, or the chest pain may be obscured by other complaints [6], [7], such as dyspnoea upon exertion, fatigue, dizziness and nausea. Secondly, if angina pectoris in women does manifest itself by way of chest pain, this pain tends to be less typical and more often an unpleasant feeling somewhere in the chest, which does not disappear within ten minutes in rest nor upon administration of nitroglycerine [8].…”

Cardiovascular disease in women: Sex differences in presentation, risk factors, and evaluation

“…Women were more likely to describe back pain, jaw pain, rest pain, pain related to mental stress, and pain that awoke them from sleep [17,[19][20][21]. Recently, McSweeney et al [22] surveyed 515 women 4 to 6 months post-MI and found that women reported atypical prodromal symptoms including unusual fatigue, sleep disturbance, and shortness of breath, during the month before their MI with only a minority reporting chest discomfort (29.7%). At the time of their MI, 43% of women did not describe any chest discomfort [23].…”

Baseline Q Waves and Time From Symptom Onset to ST-segment Elevation Myocardial Infarction: Insights From PLATO on the Influence of Sex

“…5,6 This ambiguity is even more pronounced in the female sex and likely relates, at least in part, to the lack of specificity of prodromal symptoms and the atypical clinical presentation in women. 7,8 In a prior retrospective study of STEMI patients undergoing primary percutaneous coronary intervention (PCI) within 6 hours of symptom onset, baseline Q waves emerged as a reliable independent prognostic factor and also proved to be superior to time from symptom onset in predicting 90-day clinical outcomes. 5,9 Interestingly, this electrocardiogram (ECG) metric appeared to be especially advantageous in females.…”