if they ask What is the main warning sign that you are having an acute myocardial infarction? (AMI) most likely your response is a sharp pain in the chest that radiates to the left arm. However, most of the time that is true only in 50% of the cases. Or in other words, when unemployment occurs in a man.
Knowledge of signs and symptoms of this disease is uneven between men and women. A recent study reveals how only 39% of women would be able to recognize that they have a heart attack. The men there are ahead of us: 57% would identify it. In addition, on average, it takes women 237 minutes to get to the emergency room from the onset of pain, while men only take 98 minutes. “This delay is worrying since almost half of deaths from cardiac arrest occur in the first three or four hours after the first symptoms appear,” says Catheline Lauwers, head of Cardiology at Hospital Quirónsalud Valencia.
The reason for this delay is because “many of the women confuse the symptoms of AMI with digestive or respiratory problems or anxiety disorders”, continues Dr. Lauwers.
And it is that, although acute chest pain is the most common symptom in both sexes, there are others that are frequent among the female sex: «You are short of breath and it is difficult for you to breathe. This symptom usually begins before or at the same time as the chest pain, although sometimes it is the only symptom of a heart attack; unusual pressure on the chest, as if you had a ton on you, and heartburn. In man there is also chest pressure, but in women this pressure is accompanied at the same time by burning in the upper part of the abdomen. Cold sweat, which should not be confused with the hot flashes of the menopause, but rather excessive, sudden and especially cold sweating (menopausal hot flashes cause heat); upset stomach, nausea, or vomiting. Women are twice as likely to suffer them during a heart attack. –explains the expert–. These symptoms, if they accompany any other, are a sign that something is wrong. Also inexplicable anxiety, which is usually associated with tightness in the chest. A third of those who suffer a heart attack feel it in the previous moments ».
But why are the symptoms of an acute myocardial infarction different in women and men? «The main difference is due to sex hormones. Until menopause, women are under the protective effect of estrogen so we have less risk of cardiovascular disease. After menopause the situation changes and our risk becomes equal to that of men. In both men and women, the heart attack alarm symptom is noticing oppressive pain in the chest area, which can radiate to the throat, stomach, back, left arm or both arms; More frequently, women may notice other symptoms such as dizziness, sweating, discomfort… but the most frequent symptom is chest pain,” says Esther Merino, head of the Cardiovascular Disease Prevention and Cardiac Rehabilitation Unit at Olympia Quirónsalud.
Why it happens?
To continue breaking clichés, another problem is the high prevalence of this disease among women. Although AMI has traditionally been associated with men, in 2019, the prevalence of cardiovascular diseases in Spain affected 9.8% of the population, 52.6% women and 47.4% men. Another matter to take into account is that myocardial AMI is gradually increasing among young women and those over 65 years of age.
In addition, “the risk of death in women for this reason is twice that of men (9.3% vs. 18.7%) and is partly due to less use of primary angioplasty in women” says Dr. Lauwers.
And why is this? “Several reasons are contemplated to explain it, one of the fundamental ones is the delay in reaching the diagnosis, among other causes, because women themselves take longer to seek medical help (We do not recognize the alarm symptoms, the role of caregivers in the family leads to postponing the search for medical help…)”, agrees Merino.
In addition, adds Dr. Lauwers, “a study, published in 2022, conducted in men and women with AMI (with ST elevation) shows a higher mortality for them in the short term (first month) and medium term (the first years) after the infarction. Part of this higher mortality is explained by the fact that women present AMI at an older age than men, and have more comorbidities (diabetes, hypertension, smoking, etc.). But that does not explain everything, it continues to have a higher mortality, even if we adjust it for age and other pathologies. All studies have shown that women take longer to go to the hospital, receive fewer reperfusion treatments and a lower percentage of optimal drug treatment after the heart attack,” he concludes.
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