Chest pain, age and sex are no longer the only definers of a heart attack
New study findings by a Providence Health Care (PHC) researcher warn the public and physicians that relying on traditional symptoms for heart attacks in young people and women can lead to dangerous misdiagnoses.
Researchers evaluated sex and age differences in acute coronary syndrome (ACS)—the umbrella term used to describe heart attacks and angina, which is a lack of blood and oxygen going to the heart due to an artery blockage. Results showed that one out of five women aged 55 years or less do not experience chest pain when having a heart attack.
The study, involving PHC, the University of British Columbia (UBC) and the McGill University Health Centre (MUHC), is published in this month’s issue of JAMA Internal Medicine.
“Previous research has shown that women aged less than 55 years are more likely to have their heart attacks and angina misdiagnosed in the ER than men, and they have higher risk of death,” says Dr. Khan, a scientist with the Centre for Health Evaluation and Outcome Sciences at St. Paul’s Hospital, associate professor at UBC and first author on the study. “We wanted to take a closer look at the symptoms that young women and men were having with heart attacks and angina.
While chest pain is the main symptom most commonly associated with heart attacks and angina, researchers show this is not always the case. At-risk individuals and families and health care professionals should look for the following symptoms when determining ACS: weakness, feeling hot, shortness of breath, cold sweats, and pain in the left arm or shoulder. These were the most common symptoms reported by women and men who did not experience chest pain.
Investigators evaluated more than 1,000 young patients—aged 55 or less—across Canada who were hospitalized for ACS. Their findings showed that one in five women did not experience chest pain with their heart attacks or angina, and women were less likely to experience chest pain compared with men.
The heart attacks women experienced without chest pain were no less severe compared with heart attacks in women with chest pain. Furthermore, patients without chest pain had fewer symptoms overall but their ACS was not less severe; and the diagnosis of ACS, therefore, depended on detailed cardiological assessments.
“We need to remind ourselves that even without chest pain, something serious could still be happening,” says Dr. Khan.
The study, titled “Sex Differences in Acute Coronary Syndrome Symptom Presentation in Young Patients,” has implications for improving diagnostic and treatment guidelines.
“Our study demonstrates that young people and women who come into the emergency without chest pain, but other telltale ACS symptoms, are in crisis,” says Dr. Louise Pilote, director of the Division of General Internal Medicine at MUHC and senior author on the study. “We need to be able to recognize this and adapt to new standard assessments in previously unrecognized groups such as young women.”
The study was led by the Research Institute of the MUHC, and made possible by funding from the Canadian Institutes of Health Research and the Heart and Stroke Foundation.
The study is available here
About the Centre for Health Evaluation and Outcome Sciences:
A centre of the Providence Health Care Research Institute and the University of British Columbia, the Centre for Health Evaluation and Outcome Sciences (CHÉOS) is an inter-disciplinary research collective founded to pursue excellence through the evaluation, interpretation and communication of health outcomes research. CHÉOS works across all of PHC Research Institute’s health disciplines, including aging, cardiopulmonary health, urban health, HIV/AIDS, mental health, and kidney health.
About Providence Health Care:
Providence Health Care (PHC) is one of Canada’s largest faith-based health care organizations, operating 16 facilities within Vancouver Coastal Health. Guided by the principle, “How you want to be treated,” PHC’s 1,200 physicians, 6,000 staff and 1,500 volunteers deliver compassionate care to patients and residents in British Columbia. Providence’s programs and services span the complete continuum of care and serve people throughout BC. PHC operates one of two adult academic health science centres in the province, performs cutting-edge research in more than 30 clinical specialties, and focuses its services on six “populations of emphasis”: cardiopulmonary risks and illnesses, HIV/AIDS, mental health, renal risks and illness, specialized needs in aging and urban health.
About the University of British Columbia:
The University of British Columbia (UBC) is one of North America’s largest public research and teaching institutions, and one of only two Canadian institutions consistently ranked among the world’s 40 best universities. Surrounded by the beauty of the Canadian West, it is a place that inspires bold, new ways of thinking that have helped make it a national leader in areas as diverse as community service learning, sustainability and research commercialization. UBC offers more than 50,000 students a range of innovative programs and attracts $550 million per year in research funding from government, non-profit organizations and industry through 7,000 grants.
About the Research Institute of the McGill University Health Centre:
The Research Institute of the McGill University Health Centre (RI-MUHC) is a world-renowned biomedical and health-care hospital research centre. Located in Montreal, Quebec, Canada, the Institute is the research arm of the McGill University Health Centre (MUHC) affiliated with the Faculty of Medicine at McGill University. The Institute supports over 600 researchers, over 1,100 graduate students and post-docs and fellows devoted to a broad spectrum of fundamental and clinical research. Over 1,800 clinical research studies are conducted within our hospitals each year. The Research Institute of the MUHC is supported in part by the Fonds de recherche du Québec – Santé (FRQS).