Heart attack chest pain the same for men and women

The most common symptom of a heart attack—chest pain—doesn’t differ much between men and women, according to a study published online Nov. 25 in JAMA Internal Medicine.

The study found that looking for sex-specific differences in chest discomfort—such as the location of the pain or if it was worsened by exertion—didn’t help emergency department physicians diagnose whether a woman was having a heart attack or not.

Up to 90 percent of all heart attacks involve chest pain or discomfort, according to background information in the study. But sex-specific differences in symptoms “have received increasing attention,” the authors wrote.

According to the American Heart Association, for example, women may be more likely than men to experience shortness of breath, pressure or pain in the lower chest or upper abdomen, dizziness or fainting, pressure in the upper back, or extreme fatigue.

Since chest pain is the most common symptom of heart attack for both sexes, the study’s authors wanted to find out if chest pain characteristics (CPCs) differed enough between men and women that it could help doctors more quickly diagnose heart attacks in women.

About the study

The study involved 796 women and 1,679 men who were evaluated for chest pain in emergency departments in Spain, Switzerland and Italy between 2006 and 2012.

Emergency department staff examined each patient and ordered a variety of tests, such as electrocardiograms (EKG), chest x-rays and blood tests that look for signs of a heart attack. Doctors also noted whether the person’s chest pain fell into any of 34 predefined CPCs. These included pain quality (such as whether it was pressurelike, stabbing, burning); location (such as right or left side of the chest); whether pain traveled (radiated) from the chest to arms, the jaw or other areas; whether it was accompanied by shortness of breath; how long pain lasted; and whether factors such as stress or exertion made it better or worse.

A total of 143 women and 369 men ultimately were diagnosed with heart attacks. Researchers then compared these patients’ CPCs.

The study found most of the CPCs were similar between the two sexes. Some symptoms did occur more frequently in one sex or the other, mostly relating to pain radiation or duration. For example, women were more likely than men to experience pain radiating to the back when having a heart attack. But women were less likely than men to report pain radiating to the right arm or shoulder.

Still, these kinds of subtle differences in CPCs did not help doctors distinguish whether a woman’s chest pain was caused by heart attack or some other problem.

“Our data confirm that CPCs are not powerful enough to be used as a single tool in the diagnosis of [heart attack],” the authors wrote.

Other tests—specifically, EKGs and certain blood tests—must always be done to confirm or rule out a heart attack, they added.

One of the study’s limitations is that it did not consider sex differences for other heart attack symptoms, such as nausea, vomiting and sweating. It also did not include people whose symptoms didn’t include chest pain, which the authors noted is absent in about 8 percent of people having a heart attack.

The take-home message
This study found that chest pain during a heart attack doesn’t differ significantly between men and women.

If you suspect you are having a heart attack, call 911 for immediate help.

Check out the signs of a heart attack in this infographic.

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