Women's Heart Attacks Often Undiagnosed

Heart attacks are still more likely to go undiagnosed in women than men, putting women at risk of not receiving the treatment they need.

The charge, made in a British study in the February issue of the journal "Heart", is the latest in a long line of studies that indicate women don’t always get the heart attack attention they deserve.

“It has been repeatedly shown that women diagnosed as having had a [heart attack] tend to be managed less aggressively and have a poorer prognosis compared to men,” write the researchers, who included clinical biochemist Eric Kilpatrick.

Efforts have been made to correct that. For years, experts have preached that women should take their heart attack risk seriously and that women’s symptoms may differ from those seen in men.

Classic Symptoms

For both men and women, heart attack symptoms can include:

—Squeezing chest pain or pressure

—Shortness of breath


—Tightness in chest

—Pain spreading to shoulders, neck, arm, or jaw

—Feeling of heartburn or indigestion with or without nausea and vomiting

—Sudden dizziness or brief loss of consciousness

Heart attack symptoms that are more likely in women include:

—Indigestion or gas-like pain

—Dizziness or nausea

—Unexplained weakness or fatigue

—Discomfort or pain between the shoulder blades

—Recurring chest discomfort

—Sense of impending doom

Blood Test Important

Kilpatrick blows the whistle on his own employer, England’s Hull and East Yorkshire Hospitals. Kilpatrick and S.A. Madrid Willingham studied heart attack diagnoses at the hospital in 2002.

Data came from 2,500 men and 2,300 women. First, patients were tested for a chemical called cardiac troponin T (search).

High levels of troponin are sufficient to diagnose heart attacks, according to standards set by the European Society of Cardiology and the American College of Cardiology in 2000.

Next, the researchers checked the diagnoses given to the patients when they were discharged from the hospital. The diagnoses didn’t always jive with the test results.

A total of 561 heart attacks were diagnosed. In 93 percent of those cases, the patients had high troponin levels.

But many other people with high troponin levels didn’t get a heart attack diagnosis. Only 40 percent of the patients with high troponin levels were diagnosed with a heart attack.

Women’s Disadvantage

Whereas 46 percent of men with elevated troponin were given a heart attack diagnosis, only 33 percent of such women were deemed to have had a heart attack.

Women seem less likely to be diagnosed with a heart attack despite raised troponin being a reliable test, say the researchers.

“This lack of systematic use of new criteria appears to disadvantage females more than males,” they conclude.

By Miranda Hitti, reviewed by Michael W. Smith, MD

SOURCES: Willingham, S.Heart, February 2005; vol 91: pp 237-238. WebMD Feature: “Women’s Heart Attacks: How They Differ.” News release, BMJ Specialist Journals.