MI symptom debate

  1. Today at work, a co-worker stated that she had read in a study somewhere that women have different symptoms of MIs than men-therefor the traditional assessments aren't appropriate. I am a relatively new grad- and we were taught the basic cardiac assessment, with no distinction between the sexes. She was unable to elaborate further. If there is a difference- can someone please enlighten me on what I should be focusing on verses the basics? I rely on the c/o chest discomfort/pain assessments, shortness of breath, dyaphoresis, and wacky VS. If this is different for men and women, I'd like to know what areas to focus my assessment on for women, as I care for several people with h/o cardiac problems. If anyone can help, I'd appreciate the input. Thank you!
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  2. 17 Comments

  3. by   RNonsense
    "While the symptoms for heart attack can be similar in men and women, we know from recent research that differences also exist. Some women who have experienced a heart attack reported having difficulty breathing and feeling discomfort that seemed "flu-like" (e.g., fatigue, weakness, clammy or sweaty skin), in addition to, or instead of, the other more typical heart attack symptoms, such as chest pain and pressure.

    Most of the earlier studies on heart disease focused almost exclusively on men. Lately, researchers have been including women in their studies, or focusing exclusively on women and heart disease. Although a lot more information needs to be gathered, more and more is being learned everyday about the nature of heart disease in women. While this is still an active area of research, currently we know that symptoms of heart attack can include:

    Chest pain or pressure (a feeling of heaviness) that lasts for more than a few minutes and does not go away when you rest or sit down. This is the most common symptom and must not be ignored. People who experience this symptom need to seek immediate emergency medical attention. While this symptom does not always indicate that a person is having a heart attack, this is a symptom that needs to be fully evaluated.
    Pain that spreads to the back, shoulders, neck, jaw, or arms
    Chest pain along with feeling dizzy, faint, nauseated, or short of breath
    Recent research has also shown that women can often receive different treatment for their heart disease. Women are less likely than men to get full diagnostic work-ups for chest pain, and are more likely than men to die from a first heart attack. Although no one is sure exactly why this is the case, part of the problem may be a misperception on the part of women and/or their health care providers that heart disease is something only men have to worry about. This myth sometimes leads women and their providers to skip screenings and ignore symptoms.

    According to the American Heart Association, 53 percent of people who died of heart attacks in 1998 were women. Unfortunately, four out of five women surveyed do not know that heart disease is the leading cause of death for both men and women over 40 years of age.

    To learn more about the ways in which women can reduce their risk of heart attack, go to the National Coalition for Women with Heart Disease Web site. Another resource is the National Institutes of Health (NIH) publication, Healthy Heart Handbook for Women."

    From Columbia University.

    If you do a search on plain old google "Heart attack symptoms in Women" you will get alot of further info.
  4. by   KaroSnowQueen
    Women will also have N/V as a primary symptom, which is often not assessed as cardiac related.
  5. by   jenac
    thanks-I searched ivillage and the American Heart Association. They listed the same things we're taught to look for. I'll check out google.
  6. by   hoolahan
    jenac, as a new grad, this is all anyone would expect of you to know as signs and symptoms of MI. This is a perfect example of how your nursing education does not and cannot end with graduation.

    The problem is a result of the fact that most all cardiac research was orginally done on men, and did not include women. Therefore it was an "amazing discovery" in the last decade, that women can present with very vague and non-classic symptoms.

    I can understand that your school texts may not have been up to speed with this, but surely your instructors should have mentioned it. I just recertified my CPR and the american heart assoc has not even updated the info in there either.

    If you do find any good articles, post a link here for all to see, OK? It's good to see you question things, and not just accept things that your mentors tell you, it's a sign of a good nurse in my opinion.
  7. by   gwenith
    I agree nursing is lifelong learnign and thanks for the input I learnt something today BTW what is N/V?
  8. by   hoolahan
    N/V = Nausea and vomitting
  9. by   Stargazer
    Originally posted by RNonsense
    Some women who have experienced a heart attack reported having difficulty breathing and feeling discomfort that seemed "flu-like" (e.g., fatigue, weakness, clammy or sweaty skin), in addition to, or instead of, the other more typical heart attack symptoms, such as chest pain and pressure.
    Very true. I once had a pt tell me at 3 AM that she "just didn't feel good." Because she was diabetic, she thought she was having an insulin reaction of some kind.

    After taking her history, I was about to call the doc when somewhere in the back of my sleepy brain, the fact that she was in her 50s, female, diabetic and had a mild cardiac history made me think, "Oh, I better cover my bases and get a 12-lead first, just in case." I had no real suspicion that she was having a cardiac event--she had no pain, numbness or tingling, and wasn't nauseated.

    You should've seen my eyes bug out as the 12-lead rolled off the machine. She had hugely elevated S-Ts in every lead, almost tombstones. We ended up giving her a thrombolytic. Despite that, she extended her MI and ended up going into 2nd and then 3rd-degree heart block, although she was never symptomatic. Had to get a permanent pacemaker before she went home.
  10. by   jenac
    Thanks to all who responded- here's a great site that really helped put it in perspective.
    http://www.womenheart.org/informatio..._an_attack.asp
    (RNONSENSE- ya gotta love google! )
  11. by   CCL"Babe"
    What Srargazer said is especially true, of any diabetics, no matter their sex. Diabetics and the elderly often don't have the "classic" symptoms, just vauge feelings of not feeling good or unrest. Most cardiac patients that I have taken care of have been adament that they are not having "pain", and will deny pain but admit to a host of other symptoms like pressure. Hope this helps.
  12. by   renerian
    Very true. Once you graduate you have only learned the tip of the iceberg.

    renerian
  13. by   Going80INA55
    Can we all say AMEN to that!!!
  14. by   healingtouchRN
    Yes, women usually present with "atypical chest Pain" that is sweating, nausea, vomiting, pallor, weakness, vascilation of pain. "typical chest pain" is substernal & radiating to left arm. I have seen women c/o an upper back ache @ age 28 & be treated with muscle relaxants & it was a large MI that killed her after we put her on percutaneous bypass (last ditch effort). Scary. so the best thing to do with this info if you are in triage is get a good history, quickly, PAY ATTENTION TO GUT INSTINCT, LISTEN TO YOUR PATIENT, & get a 12 lead & some CE's. You have nothing to lose by playing it safe. I have heard in my own ER stupid statements like, "she's female, she's been hurting for a couple of days, it isn't anything". We statisically, women die far more than their male counterparts because of that ignorance & becuase women don't believe they are having an MI because it doesn't meet the " typical chest pain" requirements. If they look bad, just get the 12 lead with in the first 5 minutes! They DOCs will thank you! I know I have been thanked on more than one occasion----"good save!"

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