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Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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Recognizing Heart Attacks in Women

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We have long been taught that the typical symptoms for a heart attack are substernal (beneath the breastbone) chest pain that is pressure-like or “squeezing” in nature, radiation of the chest pain to the left arm or jaw, sweating, nausea, and weakness. Similar symptoms of a lesser intensity are often attributed to angina, which is a premonitory condition prior to a full-blown heart attack (myocardial infarction). 

But it doesn’t always happen like they write in the textbooks. In a recent article entitled “Association of Age and Sex with Myocardial Infarction Symptom Presentation and In-Hospital Mortality” published in the Journal of the American Medical Association, Robert Goldberg, PhD and his colleagues noted that women who are hospitalized with heart attacks are generally older than men, and that they also present less frequently with chest pain or chest discomfort. They confirmed this by looking at a registry that included nearly a million and a half patients who had suffered heart attacks. Their refined observations included the fact that younger women suffering heart attacks were more likely to not complain of chest pain. In addition, young women without chest pain who were hospitalized with heart attacks had higher in-hospital mortality rates than did younger men without chest pain. Finally, they noted that as the presenting age increased of both men and women with heart attacks, there were fewer tendencies for the women to be without chest pain and the mortality differences were attenuated. So, this appears to be a phenomenon related to younger patients.

What is considered “young” for a patient with a heart attack? From the statistics in this paper, under the age of 54 years was most impressive, but this number will likely increase. From a clinician’s perspective, it would lead me to be more cautious when a young woman with risk factors (e.g., diabetes. obesity, tobacco use, unsatisfactory lipid profile, family history, and high blood pressure) complains of “atypical” (for a heart attack) symptoms. These would include chest pain that is not classical in its character, intensity, or location. If you are a woman who falls into that category, and are contemplating an outdoor adventure that involves significant physical stress or a journey far from medical care, it would be prudent to see a physician for a thorough evaluation, including your heart, prior to the adventure.

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Tags: Staying Safe , General Interest

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About the Author

Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.

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