From the Guidelines
Women with myocardial infarction (MI) often present with atypical symptoms, including indigestion, dyspnoea, epigastric, shoulder, arm or back pain, fatigue or weakness, rather than the typical chest pain experienced by men. These symptoms can be subtle and may appear gradually, making it essential to recognize them for timely medical intervention 1. According to the 2021 narrative review on heart disease in women, women more often describe atypical chest pain or symptoms, and these patients require an urgent ECG to diagnose ST-segment elevation myocardial infarction 1.
The symptoms of MI in women can be diverse and may include:
- Unusual fatigue
- Sleep disturbances
- Shortness of breath
- Indigestion or upper abdominal pressure
- Back, neck, or jaw pain
- Nausea, vomiting, and lightheadedness
- Subtler chest discomfort, described as pressure, tightness, or burning
- No chest pain at all
These atypical symptoms can lead to delayed treatment seeking and misdiagnosis, contributing to higher mortality rates in women with MI 1. The 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain also highlights the importance of recognizing sex differences in the presentation of chest pain, as traditional risk score tools and physician assessments often underestimate risk in women 1. Recognizing these gender-specific symptoms is crucial for timely medical intervention and improving outcomes in women with MI.
From the Research
Common Symptoms of Myocardial Infarction in Women
- Typical symptoms such as chest, arm, or jaw pain are common in both women and men with myocardial infarction (MI), but women are more likely to present with atypical symptoms 2, 3
- Atypical symptoms in women with MI include nausea, vomiting, shortness of breath, palpitations, dyspnea, fainting, pain in the back, and pain between the scapulas 2, 3
- Women with MI are also more likely to experience prodromal symptoms such as fatigue in the days leading up to the MI 2, 4
- The presentation of symptoms in women with MI can be influenced by their expectations of symptoms, with some women being less likely to attribute their symptoms to a cardiac cause 3, 4
Differences in Symptom Presentation between Women and Men
- Women are less likely than men to experience chest symptoms with MI 3
- Men are more likely to have a silent or unrecognized MI, which may contribute to their higher overall rate of MI 2
- Women with MI tend to be older and have more comorbidities than men with MI 2
Implications for Diagnosis and Treatment
- The atypical presentation of symptoms in women with MI can lead to delays in diagnosis and treatment 5
- Healthcare providers should be aware of the potential for atypical symptoms in women with MI and consider this when evaluating patients with suspected cardiac disease 2, 5
- Further research is needed to understand the underlying causes of the differences in symptom presentation between women and men with MI and to develop effective strategies for improving diagnosis and treatment in women 2, 4