Health: WOMEN are more likely to confuse heart attack symptoms with stress or anxiety than men

Women with heart attacks are more likely than men to have their chest pain symptoms misdiagnosed by doctors as anxiety or stress, a study warned.

Spanish researchers analyzed the treatment of 41,828 patients admitted to hospital with chest pain and compared the treatment they received.

Women were almost twice as likely as men to have a case of acute coronary syndrome – including a heart attack – initially misdiagnosed.

But doctors weren’t the only ones misjudging the circumstances, the team found, with women being more likely than men to wait more than 12 hours before seeking help.

A 2014 study, meanwhile, found that women with heart attacks are also more likely to have to wait longer to be seen in hospital than men.

“ Our results suggest a gender gap in the first assessment of chest pain, with the likelihood of heart attack being underestimated in women, ” author Gemma Martinez-Nadal of the Barcelona Hospital Clinic said, in Spain.

“The low suspicion of a heart attack occurs both in women themselves and in doctors, leading to higher risks of late diagnosis and misdiagnosis.

In their study, Dr Martinez-Nadal and his colleagues studied the experiences of a total of 41,828 patients admitted to a hospital emergency room with chest pain between the years 2008 and 2019.

Among the patients, 42% were women and the median age was 65 years for women and 59 years for men.

For each subject, the researchers gathered information about their risk factors for heart attack – including whether they were obese or had high blood pressure – and the doctor’s initial diagnosis of the case.

“We got the doctor’s first impression as to whether the chest pain had a coronary cause or some other origin, such as anxiety or a musculoskeletal disorder,” explained Dr. Martinez-Nadal.

These first impressions are recorded before examinations such as blood tests, and are instead given on the basis of the patient’s clinical history, a physical examination, and an electrocardiogram (ECG) measurement of heart activity.

The researchers found that women were much more likely to present to the hospital more than 12 hours after the onset of chest pain – this happened in 41 percent of women compared to 37 percent of men.

“This is worrying because chest pain is the main symptom of decreased blood flow to the heart – ‘ischemia’ – because an artery has narrowed,” said Dr Martinez-Nadal.

“It can lead to a myocardial infarction which requires prompt treatment,” she added, referring to the disease better known as heart attack.

The team found that doctors were much more likely to attribute chest pain to acute coronary syndrome – an umbrella term for a condition such as heart attacks that involve decreased blood flow to the heart – if the patient was a man.

Specifically, in the 93% of cases in which the ECG was unable to provide a definitive diagnosis, doctors suspected acute coronary syndrome in 44.5% of men but only 39% of women.

In addition, this trend has been maintained regardless of the number of risk factors for heart attack patients or whether they present typically indicative chest pain.

Acute coronary syndrome was initially misdiagnosed in 5% of women, but only 8% of men.

“According to the doctor’s first impression, women were more likely than men to be suspected of having a non-ischemic problem,” said Dr Martinez-Nadal.

“Risk factors such as hypertension and smoking should raise a stronger suspicion of possible ischemia in patients with chest pain.

“But we found that women with risk factors were even less likely than men to be classified as ‘probable ischemia’.”

“Heart attack has traditionally been viewed as a male disease and has been under-studied, under-diagnosed and under-treated in women, who can attribute symptoms to stress or anxiety,” concluded Dr. Martinez- Nadal.

“Women and men with chest pain need urgent medical attention.

The full results of the study are presented at the 2021 European Society of Cardiology Congress on Acute Cardiovascular Care, which takes place from March 13-14, 2021.