Unusual Fatigue May Be Sign Of Heart Attack In Women

Researchers Find Early Symptoms Could Warn Women

In a study of women who had heart attacks, symptoms such as unexplained fatigue or trouble sleeping were experienced as much as a month before the heart attack, indicating the possibility that acting on these advance symptoms could prevent an impending heart attack.

The study, one of the first comprehensive examinations of issues that might allow prevention of imminent heart attack in women, is reported in Circulation: Journal of the American Heart Association.

“Since women reported experiencing early warning signs more than a month prior to the heart attack, this could allow time to treat these symptoms and to possibly delay or prevent the heart attack,” Dr. Jean C. McSweeney, lead author and a nursing professor at the University of Arkansas for Medical Sciences, says in a press statement.

According to the American Heart Association (AHA), coronary heart disease and stroke, remain the leading causes of death of  US women, with nearly 45 percent of all female deaths occurring from cardiovascular disease.

Cardiovascular disease is a particularly important problem among minority women. The death rate is 69 percent higher in black women than in white women due to cardiovascular disease. It is estimated that one in two women will eventually die of heart disease or stroke, compared with one in 25 who will eventually die of breast cancer, the AHA states.

Women With Heart Attacks Surveyed

In the new study, researchers recruited 515 women diagnosed with a heart attack and discharged from five different medical sites in Arkansas, North Carolina, and Ohio within the previous four to six months. The women were age 66 on average, and 93 percent were Caucasian, 6.2 percent African American, and 0.4 percent Native American. Data collection occurred over three years.

To assess symptoms that might suggest an imminent heart attack, the researchers used the McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey (MAPMISS), a telephone research tool developed by Dr. McSweeney and her colleagues. 

The survey lists 33 early, or prodromal, signs and 37 acute symptoms that women identified in previous studies. 

The researchers defined prodromal signs as being new or changing in intensity or frequency before the heart attack, being intermittent before the heart attack, and disappearing or returning to previous levels after the heart attack. 

Acute symptoms were defined as those appearing with the heart attack and not resolving until women received treatment.

The survey also included questions about other health problems, risk factors, medications, and demographics.

Women Report Early Symptoms

About 95 percent of women reported having new or different symptoms more than a month before their heart attacks that resolved after their heart attacks. This led them, in retrospect, to believe that these symptoms were related to the subsequent heart attack. 

The most common early symptoms were:

• unusual fatigue - 70 percent
• sleep disturbance - 48 percent
• shortness of breath - 42 percent
• indigestion - 39 percent
• anxiety - 35 percent

Only 30 percent reported chest discomfort before their heart attack. They described the discomfort in terms like aching, tightness and pressure – not pain, Dr. McSweeney said.

“Women need to be educated that the appearance of new symptoms may be associated with heart disease and that they need to seek medical care to determine the cause of the symptoms, especially if they have known cardiovascular risks such as smoking, high blood pressure, high cholesterol, diabetes, overweight, or a family history of heart disease,” she said.

Previous research by Dr. McSweeney found that women who later identified an array of symptoms occurring before their heart attacks either ignored the signs or were misdiagnosed when they sought medical assistance.

Dr. McSweeney emphasized the importance of health care providers being aware of the symptoms women experience. While these early symptoms may not be specific in predicting an imminent heart attack, the “appearance of these symptoms, in conjunction with women’s standard cardiovascular risk factors, may assist providers in determining at-risk women who should undergo cardiovascular diagnostic tests,” she said.

Little has been known about the acute warning signs that women experience with heart attack, she said. But it is clear that women’s experiences differ from the symptoms they expect.

Chest Pain Not a Major Symptom in Women

In this study, researchers found that 43 percent of women reported no chest discomfort during their heart attack. For those who did, the main locations were in the back and high chest.

“Lack of significant chest pain may be a major reason why women have more unrecognized heart attacks than men or are mistakenly diagnosed and discharged from emergency departments,” Dr. McSweeney said. “Many clinicians still consider chest pain as the primary symptom of a heart attack.”

Other acute symptoms women reported were:

• shortness of breath - 58 percent
• weakness - 55 percent
• unusual fatigue - 43 percent
• cold sweat - 39 percent
• dizziness - 39 percent

The researchers noted that the study sample was primarily Caucasian. “We do not know if women’s early warning and/or acute symptoms may vary according to their race, but we will address this issue with our ongoing study with minority women,” Dr. McSweeney explained.

Also, there was not a control group of women without diagnosed heart disease, so it is unknown how many of these women might experience similar preliminary symptoms. Further research is needed to address these issues.

Always consult your physician for more information.

Online Resources  

American Heart Association

Centers for Disease Control and Prevention (CDC) 

HealthierUS.Gov

National Heart, Lung, and Blood Institute (NHLBI) 

National Institutes of Health (NIH)

December 2003

Unusual Fatigue May Be Sign Of Heart Attack In Women

Women With Heart Attacks Surveyed

Women Report Early Symptoms

Chest Pain Not a Major Symptom in Women

Study Shows Coronary Bypass Benefits Older People

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Find a St. John's Mercy Physician

In Other News About Your Heart Health:

Study Shows Coronary Bypass Benefits Older People

Coronary artery bypass surgery offers people over age 75 as much improvement in quality of life as it does younger people, according to a study reported in the Journal of the American College of Cardiology.

"Age used to be a more important indicator of the risks and benefits of procedures than it is today," says study author Dr. John Spertus, a professor at the University of Missouri.

"While older patients did have a slower pace of recovering physical function, relief of [chest pain] was just as brisk as it was for the younger patients and the quality of life improvements were just as much," adds Dr. Spertus, who studies the outcome of cardiovascular treatment at Saint Luke's Hospital in Kansas City.

Coronary artery bypass surgery is an invasive procedure in which surgeons take a piece of a healthy blood vessel and use it to make a detour around the blocked portion of a coronary artery.

Dr. Spertus and his colleagues asked 690 people undergoing coronary bypass surgery to complete a questionnaire designed to assess their quality of life and physical functioning before the surgery and one year later. Of these participants, 156 were over age 75.

The researchers also asked 224 people from the 690 to complete questionnaires monthly for the first six months.

The mortality rate during surgery was just over 2 percent for the group under 75 years old and slightly higher for the group over 75. People over 75 were also more likely to die in the year following surgery - 11.5 percent, compared to 5.4 percent for the younger patients.

But, when the researchers looked at symptom relief, the older group fared just as well as the younger group.

"There's a sense that doing a very invasive, open procedure like bypass surgery on older patients subjects them to a lot of risk and potential pain, so one would want to be sure that there were benefits to offset the risk," Dr. Spertus explains.

"What we found was that compared to younger patients, older patients got just as much benefit in terms of quality of life," he says.

Dr. Stephen Siegel, a cardiologist at New York University Medical Center, says this is a very helpful study that supports the current standard of care.

"It's clear that older patients take longer to recover, but when they do they can have a very good quality of life and enjoy life," Dr. Siegel says. "I don't see any reason why we should be more concerned about adding five years of life to a 60-year-old than an 80-year-old."

Both Dr. Spertus and Dr. Siegel say it is very important that older people are involved in the decision-making process and are well-informed about the surgery and its risks and benefits.

Always consult your physician for more information.