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Younger Women Often Miss Signs of Heart Attack
Date:5/2/2008

Small study found they attributed symptoms to stress, indigestion and fatigue

FRIDAY, May 2 (HealthDay News) -- Many younger women ignore or simply don't recognize the warning signs of a heart attack, often because it doesn't resemble the typical "Hollywood heart attack."

So say the authors of a study being presented Friday at the American Heart Association's annual Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke, in Baltimore.

"So many women said, 'We wish we had a better stereotype, you never see anything in the media,'" said study author Judith Lichtman, an associate professor of epidemiology and public health at Yale School of Medicine. "I personally would love to see some cutting-edge TV series of, for example, a young person having a heart attack with atypical symptoms."

"The classic image of someone having a heart attack is someone like John Belushi. It's a heavy man clutching his chest. We never think of young women as having heart disease, so the image is not part of their consciousness," added Dr. Suzanne Steinbaum, director of Women & Heart Disease at Lenox Hill Hospital in New York City. "It's so important that we not only tell women that heart disease doesn't necessary have to look like [a Hollywood script], but they have to understand what makes them at risk."

Heart disease is the leading killer of American women, claiming almost half a million lives a year, or about one death per minute. According to background information from the authors, 16,000 young women with heart disease die every year and 40,000 are hospitalized.

Last year, a study from the same group of researchers found that women under the age of 55 often fail to recognize the symptoms of a heart attack until it's too late.

Eighty-eight percent of women in that trial reported traditional symptoms of severe chest pain. Yet only 42 percent suspected something was wrong with their heart.

Only half of the women experiencing heart attack symptoms sought care within the first hour, apparently because they thought their symptoms weren't real or weren't serious.

For this study, researchers conducted in-depth interviews with 30 women aged 55 and older a week after they had been discharged from the hospital following a heart attack.

Many didn't realize the symptoms were due to a heart attack. For example, one woman said she was told she was experiencing symptoms of acid reflux. Others attributed symptoms to fatigue, overexertion or stress.

Often, the symptoms just didn't line up with how heart attacks are presented in the popular media.

"I [had] probably seen a show or something with somebody having a heart attack," said one woman. "And they fall. They grab their chest. And then they grab their arm... I mean, you don't see anybody saying I have pain in my jaw or especially a heart attack, you don't see them vomiting . . . I did not know that and it's probably because of television, I would say is why I thought it would just be in the chest."

Similarly, another woman told investigators, "It's like... I didn't have any of the typical heart attack symptoms that you always hear about on TV and the ER hospital shows."

Some delayed treatment because symptoms went away for a while, or because they were too busy or had experienced prior, negative encounters with the health-care system (" . . . they throw you out, you know," said one woman. "If you don't have the money right there, then in two days you're gone").

One woman said she called her doctor about chest pains but was scheduled for a regular appointment in five days. Another woman who went to the emergency room spent an hour trying to find a supervisor to help her after a "rude" nurse just kept telling her to have a seat.

"A lot of women were triaged for a regular visit or, even in the ER, were being looked up for a lot of things other than a heart attack," Lichtman said.

Ironically, for some women, it was actually a relief to know that they were having a heart attack, that finally the mystery was over, Lichtman said.

Lichtman and her colleagues will be looking at this issue in more depth in a U.S. National Institutes of Health-funded study enrolling 2,000 women under 55 and 1,000 men in the same age range.

"A little bit of empowerment goes a long way," Steinbaum said. "Knowing your risk and knowing the potential for heart disease, seeking early care for symptoms that are really unclear and then saying, 'I am at risk for heart disease, please help me' becomes important in the paradigm of how this needs to develop."

More information

Visit the American Heart Association's Go Red For Women for more on women and heart disease.



SOURCES: Judith Lichtman, Ph.D., associate professor, epidemiology and public health, Yale School of Medicine, New Haven, Conn.; Suzanne Steinbaum, D.O., director, Women and Heart Disease, Lenox Hill Hospital, New York City; May 2, presentation, American Heart Association's Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke, Baltimore


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