MONDAY, Nov. 3, 2003 (HealthDayNews) -- Researchers have identified several early warning signs that may presage heart attacks in women.
Severe, unexplained fatigue, trouble sleeping and shortness of breath were the main troubling symptoms that occurred in women in the month or so preceding a heart attack, reports a study in the Nov. 4 issue of Circulation.
Chest pain, long considered the classic heart attack symptom, was notably absent or was described not as pain but as aching, tightness or pressure.
"Less than 30 percent of the women actually complained of chest discomfort. That's the symptom we associate with the typical patient, but it's the typical male patient," says Dr. Nieca Goldberg, a cardiologist with Lenox Hill Hospital in New York City and author of Women Are Not Small Men.
"We need to change the picture a little, and also include women. Women have heart attacks too, but the symptoms may, in fact, be much different and more subtle," she adds.
The findings could have significant implications for the prevention of heart attacks in women, who tend to experience more sudden cardiac deaths than men. This study may help explain why that is.
"Getting a good medical history could help pick these women out much earlier and really nip it in the bud," Goldberg says. "This is clearly significant."
The researchers recruited 515 women who had had a heart attack in the previous four to six months. Most of the women (93 percent) were white and the average age was 66. This was the first heart attack for 72 percent of the study participants.
The women were asked to recall any physical changes that might have occurred before their heart attack. Before being enrolled in the study, the women underwent cognitive tests to make sure their memory was intact, says study author Jean McSweeney, a professor in the College of Nursing at the University of Arkansas for Medical Sciences.
The vast majority of the study participants (95 percent) reported having new or different symptoms a month or so before their heart attacks that went away after the heart attack. The most common symptoms were unusual fatigue (71 percent), sleep disturbances (48 percent), shortness of breath (42 percent), indigestion (39 percent) and anxiety (35 percent). About 44 percent of the women said the sleep disturbances were severe, while 42 percent said the fatigue was severe.
The most frequent acute symptoms were shortness of breath (58 percent), weakness (55 percent), and fatigue (43 percent).
Slightly less than 30 percent reported chest discomfort, but it was described as aching, tightness or pressure, not pain. Forty-three percent reported no chest discomfort during the heart attack.
Two potential limitations of the study are that there was no control group of women without heart disease and the group was also almost all white, limiting the relevance of the findings to women of other races.
It's not clear why men and women may have such different experiences. "It may be that there are some vascular arterial spasms but we just don't know," McSweeney says.
What is known is that women and health-care professionals alike need to be made more aware of these signs.
"This is something that would be nice to put out to women, if they are experiencing an unusually severe fatigue and they haven't really changed anything else in their life to please get that looked at," Sweeney says. "Women also need to describe their symptoms to physicians better. They can't just go in and say 'I'm tired.' They need to tell the doctor what they can't do that they were capable of doing."
Sweeney says women have told her over and over again that they are only able to make one side of the bed before becoming exhausted and needing to rest.
Although more studies need to be done to establish the validity of these symptoms, the current findings can be incorporated into practice right now. "This is going to have almost immediate clinical utility," Goldberg says.
More information
For more on women and cardiovascular disease, visit the National Coalition for Women With Heart Disease or the American Heart Association.
