Chest pain is not a symptom
that doctors can use to accurately diagnose a woman suffering a major heart
attack, according to new research.
A survey of about 800 women
and 1 700 men found that women tend to suffer the same types of chest pain as
men during a heart attack, Swiss researchers from the University Hospital Basel
However, most of the chest
pain symptoms reported by women could not be used to tell a heart attack from
some other cause of severe chest pain.
Doctors said the study,
which was published in the journal JAMA Internal Medicine, provides
further evidence that emergency-room doctors should use concrete heart tests to
diagnose a heart attack.
These tests include the
electrocardiogram (EKG), which checks the heart's electrical activity, and the
cardiac troponin test, which is a blood test that checks for proteins called
troponins that are released when the heart muscle is damaged.
"Doctors must be much
more aggressive in trying to diagnose heart disease through EKG and troponins,
because without those objective data it's very hard to tell it's a woman's
heart," said Dr Suzanne Steinbaum, director of women and heart disease at
Lenox Hill Hospital in New York City. "The symptoms aren't going to tell
us. We have to use the diagnostic tools we have."
Some physicians, however,
expressed concern that these findings, while important to doctors, would prompt
some women to ignore chest pain that otherwise would have sent them to the
hospital for testing.
"We use symptoms to
try to drive people to the hospital, but we would never diagnose a heart attack
by symptoms alone," said Dr Nieca Goldberg, a cardiologist and medical
director of the Joan H. Tisch Centre for Women's Health at NYU Langone Medical Centre
in New York City.
"If you are
experiencing chest pain, the most important thing is you get to the hospital as
soon as possible. If any of the symptoms of heart attack come on all of a
sudden, don't just ignore it."
Chest pain characteristics
About nine out of 10 people
suffering a heart attack complain of chest pain or discomfort, the researchers
said. But there are many other medical problems that can also cause chest pain,
in addition to heart attacks.
Women also are more likely
to experience other common signs of heart attacks. These include shortness of
breath, nausea, vomiting, and pain in the back, neck or jaw.
The Swiss study involved
nearly 2 500 people suffering from severe chest pain who went to one of nine
different emergency rooms.
Of those people with chest
pain, only 18% of women and 22% of men were actually suffering a heart attack,
the researchers found.
No accurate early diagnosis
Looking at the women, the
researchers assessed the ability of 34 different chest-pain characteristics to
accurately determine whether the patient was having a heart attack.
These included things like
the location of the pain, where the pain radiated from, what the pain felt like,
and whether movement, breathing or other factors aggravated the pain.
Although some differences
emerged, they were too small to support their use in the early diagnosis of
heart attack in women, the researchers said.
"None of the chest
pain characteristics were helpful in differentiating [heart attack] from other
causes of chest pain," Steinbaum said. "If a woman had chest pain, it
was very difficult to determine if that chest pain was her heart."
For more information on
women's heart attack symptoms, visit the American Heart Association.