MI symptom debate

[jenac]

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!

[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!"

[Shamrock, BSN, RN]

I've read somewhere that low back pain and stomach pain may also be s/s of MI.

[Bonnie Blue]

Great discussion! I, too, have read that women can have a defferent presentation with MI. Other red flags should be your risk factors: HTN, cholesterol, DM (big one!), smoking and family history. Another problem is that gallbladder disease can be mistaken for a MI and vice versa. The old stand-by of good history and physical along some simple tests, 12-lead and CEs could save a woman's life.

soapbox: I get frustrated sometimes because heart disease kills more women than breast cancer but breast cancer gets all the attention!

Stepping down now.

[sunnygirl272]

My mother (also a nurse) never had any Sx that she attributed to cardiac....until she coded at work...thrombolytics failed...after a day or 2 int the unit, and finally being transferred to a Syracuse hosp,(local hosp doesn't to caths...)...the cath showed 2 areas of scarring, one at the apex with a muscle aneurysm...they pondered doing a muscle resect along w/ her cabg and aicd placement, but ended up using the pads to reinforce that area.

[susanmary]

Sometimes even a TOOTHACHE can be a subtle sign.

[obeyacts2]

Hmmm.....A few of the ladies Ive cared for with MIs had N/V as a main symptom.....My Dad who had several MIs, but one really bad one had no chest pain....thought he had the flu with N/V etc. Stayed in bed over the wekend, becuase he has a Dr appt Monday. He wasnt alarmed, DROVE to the Dr, Dr looked at him got a 12 lead and said "Mr N....do you hear those sirens in the distance...they are coming for you" and informed him he did not have the flu. Dad got a long stay in hospital and a pacer out of that one.

laura