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Heart Attacks Often Go Unrecognized

Some estimates run as high as 43 percent; women frequently under-diagnosed

THURSDAY, July 27, 2006 (HealthDay News) -- Cardiologists have made impressive strides in the treatment of heart attacks in recent years. But if a patient -- or his or her doctor -- doesn't realize a heart attack is occurring, those advances can be for naught.

Heart attacks often go unrecognized, although experts disagree on just how often. One recent study suggested that 43 percent of attacks -- more than four in 10 -- may go undetected when they occur, and more often in women than men. While other experts say that estimate is too high, they concede that unrecognized attacks are a problem.

On one point all agree: Both women and men need to know the warning signs of a heart attack and to seek immediate help if they suspect one. The worst that can happen if you're wrong? You'll be sent home from the emergency room, secure in the knowledge it was a false alarm.

Dr. Rita Redberg, a professor of medicine at the University of California, San Francisco, said, "People often ignore the warning signs of a heart attack." Sometimes, it's a case of denial. Other times, people wrongly write it off as indigestion or stress, she said.

According to the American Heart Association, the warning signs of a heart attack typically include:

  • Chest discomfort in the center of the chest that lasts more than a few minutes, or that goes away and then returns. It can feel like uncomfortable pressure, squeezing, fullness or pain.
  • Discomfort in other areas of the upper body, such as pain or discomfort in one or both arms, the back, neck, jaw or stomach.
  • Shortness of breath, with or without chest discomfort.
  • A cold sweat, nausea or lightheadedness.

Women are more likely than men to experience such symptoms as shortness of breath, nausea and vomiting, and back or jaw pain.

Dutch researchers reported the finding that 43 percent of heart attacks are unrecognized in a study published earlier this year in the European Heart Journal. They analyzed the electrocardiographs (ECGs) of more than 4,000 men and women over age 55, all participants in the so-called Rotterdam Study.

The researchers gave the men and women a baseline ECG screening during the years 1990 to 1993, then repeated the ECGs during either 1994 to 1995, or 1997 to 2000. The imaging tests revealed that over 4 out of 10 heart attacks went unrecognized -- including one-third of attacks in men and more than one-half in women, the study said.

The researchers think the results could apply to any developed country.

Redberg acknowledged that heart attacks can -- and do -- go unrecognized, but she said using an ECG alone is not proof-positive of a heart attack. "An abnormal ECG could indicate a lot of conditions besides heart attack," she said. Even so, she added, people do ignore warning signs and many heart attacks do go unrecognized.

Dr. Susan Bennett, director of George Washington University Hospital's Women's Heart program, said even a doctor may not recognize a heart attack, especially in women. "Physicians typically under-evaluate and under-treat women," she said.

A special report published last year in the journal Circulation polled 500 physicians online, including primary-care doctors, obstetricians/gynecologists and cardiologists. They were given an experimental case study and asked to categorize the patient's level of heart-disease risk. The authors found that women at intermediate risk were more likely to be assigned to a lower-risk category than men with identical risk profiles.

Bennett said the decision to evaluate a patient for a possible heart attack depends on the "index of suspicion." And often, that suspicion is not high enough for women, she said. "When they [doctors] see a woman who is white, on the thinner side, they get that reflex that this is a lower-risk person," she said.

Of course, even better than recognizing a heart attack early on is focusing on preventing one. "Know your numbers," Bennett advised. That means knowing your blood pressure as well as your cholesterol levels. Focus, too, she said, on a healthful diet and a healthful weight. Aim for a body mass index (BMI, a ratio of weight to height) below 25: that's equal to less than 150 pounds for a person 5-feet, 5-inches tall, and less than 175 pounds for a person 5-feet, 10-inches tall.

More information

To learn more about heart-attack warning signs, visit the American Heart Association.

SOURCES: Susan Bennett, M.D., cardiologist, director, Women's Heart Center, George Washington University Hospital, Washington, D.C.; Rita Redberg, M.D., M.Sc., professor of medicine, University of California, San Francisco, and scientific advisor, Choose to Move Program, American Heart Association; Nieca Goldberg, chief, women's cardiac care, Lenox Hill Hospital, New York City
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