Younger Women Too Often Ignore Signs of Heart Attack

Blame Hollywood. Or, at least, partly blame Hollywood. (We’ll take what we can get.)

Women ages 30 to 55 too often ignore the warning signs of an acute myocardial infarction (AMI), according to a study in Circulation: Cardiovascular Quality and Outcomes. They either don’t recognize more nuanced symptoms (dizziness, aching muscles, indigestion, fatigue), or they fear that their interpretation may be wrong. They often believe that a heart attack must always include an episode of intense chest pain, and while more than 80% of men and women in that age range with AMI do have chest pain, younger women are more likely to not have it

“Women described having symptoms that differed significantly from their expectations of AMI as portrayed by the media, noting theirs was not a Hollywood heart attack,” the study states. As one interviewee puts it, “I didn’t have any of the typical heart attack symptoms that you always hear about on TV and the ER hospital shows.”

Nonetheless, what they experience is all too real, because women in this demographic are twice as likely to die during hospitalization for AMI than men of the same age; and about 55,000 younger women die each year from the disease, making it the leading cause of death among young women. Yale researchers pinpoint five reasons they ignore symptoms or don’t get the help they need in time:

  • Symptoms vary substantially in nature and duration
  • They do not appreciate how at risk they are and think that the symptoms are not heart related
  • Other priorities (work, family) trump seeking care
  • The health care system often responds too slowly in emergencies
  • Many women do not use the health care system in a consistent way before emergencies

Researchers used a qualitative approach, conducting in-depth interviews with 30 women between October 2006 and May 2007. They stopped the interviewing process at the “saturation” point; when the last few interviews after number 30 provided no new information.

Researchers note a strong “it can’t happen to me” effect, even in women with a history of AMI in their families. Such patients just think they’re too young to worry about it. The study suggests targeted educational campaigns for this cohort.

The patients aren’t the only ones who need to be educated, though. Providers too often discount the possibility that a relatively young woman experiences a heart attack. One interviewee says that her doctor told her that the symptoms for acid reflux often mimics AMI symptoms. “And then throughout, until this last time, anytime that it happened, [I] thought, OK, acid reflux.”

Researchers cite previous negative experiences, such as a poor doctor-patient relationship, being rebuffed or treated disrespectfully, and basically denied care.

“Our participants described delays that occurred for both the typical and the atypical symptoms, as well as delays within the physician’s office and the emergency department,” the study states.

Many women also worry about looking like a hypochondriac. “I know I had too much to do to be wimpy about being sick,” says one interviewee. “…I have worked through the flu. Just feeling like I’ve got to get the job done. You’d think I was the President of the United States.”