Scientific tools, not patient complaints, needed for accurate diagnosis, expert says
MONDAY, Nov. 25, 2013 (HealthDay News) -- 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 said.
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 Nov. 25 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 Center for Women's Health at NYU Langone Medical Center 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."
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 percent of women and 22 percent of men were actually suffering a heart attack, the researchers found.
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."
Another expert said more and better study on the issue may be needed.
Dr. Sonia Henry is a cardiologist at Long Island Jewish Medical Center in New Hyde Park, NY. She noted that women made up only about a third of study participants, and they tended to be much older than male patients.
"Age in itself already significantly changes the risk assessment we are trained to use," Henry said. "It is clear, more work needs to be done with age-matched, risk factor-matched men and women with and without chest pain."
For more information on women's heart attack symptoms, visit the American Heart Association (http://www.heart.org/HEARTORG/Conditions/HeartAttack/WarningSignsofaHeartAttack/Heart-Attack-Symptoms-in-Women_UCM_436448_Article.jsp ).
SOURCES: Suzanne Steinbaum, M.D., director, women and heart disease, Lenox Hill Hospital, New York City; Sonia Henry, MD, cardiologist, Long Island Jewish Medical Center, New Hyde Park, NY; Nieca Goldberg, M.D., cardiologist and medical director, Joan H. Tisch Center for Women's Health, NYU Langone Medical Center, New York City; Nov. 25, 2013, JAMA Internal Medicine