Early warnings of heart attacks

The study, published online Monday by Circulation: Journal of the American Heart Association, is one of the first comprehensive examinations of women's heart-attack symptoms, which experts are coming to realize are quite different and often more subtle than those experienced by men.

The 515 women in the study, with an average age of 66, were diagnosed with a heart attack and discharged from five hospitals in Arkansas, North Carolina and Ohio within the previous four to six months.

The most frequently reported symptoms were unusual fatigue (70.7 percent); sleep disturbance (47.8 percent) and shortness of breath (42.1 percent). Fewer than 30 percent of the women reported having any chest pain or discomfort before the heart attack, and 43 percent didn't experience chest pain when they actually suffered the attack.

"Increasingly, it is evident that women's symptoms (of a heart attack) are not as predictable as men's. This study offers hope that both women and clinicians will realize the wide range of symptoms that can indicate a heart attack," said Patricia Grady, director of the National Institute of Nursing Research, which paid for the study.

Those women who did experience chest discomfort before the heart attack described it in terms of aching, tightness or pressure, rather than pain, the researchers said. Yet most medical professionals continue to consider chest pain as the most important symptom of acute myocardial infarction in both women and men.

"Since women reported experiencing early warning signs more than a month prior to heart attack, this could allow time to treat these symptoms and to possibly delay or prevent the heart attack," said Jean McSweeney, lead author of the study and a professor in the College of Nursing at the University of Arkansas for Medical Sciences in Little Rock.

Previous research by McSweeney and colleagues found that women who later identified an array of symptoms occurring before their heart attacks either ignored the signs or were misdiagnosed when they sought medical care.

McSweeney said that in the latest study, "symptoms such as indigestion, sleep disturbances or weakness in the arms, which many of us experience on a daily basis, were recognized by many women in the study as warning signs for a heart attack. Because there was considerable variability in the frequency and severity of symptoms, we still need to know at what point these symptoms help us predict a cardiac event."

More study is needed to help sort out the prevalence of each symptom in people at imminent risk for heart attack, and McSweeney said there's particularly a need to understand how often women not diagnosed with heart disease report similar problems.

Even so, women should be aware that when new unexplained symptoms appear, "they need to seek medical care to determine the cause of the symptoms, especially if they have known cardiovascular risks such as smoking, high blood pressure, high cholesterol, diabetes or a family history of heart disease," McSweeney said.

The most common acute symptoms during heart attacks were shortness of breath (58 percent); weakness (55) percent; unusual fatigue (43 percent); cold sweat and dizziness (both 39 percent).

McSweeney also noted that 93 percent of the women in the study were white, and cautioned "we do not know if women's early warning or acute symptoms may vary according to their race, but we will address this issue in an ongoing study involving minority women."

On the Net:

www.americanheart.org

www.nih.gov/ninr