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Medical Author:

Daniel Lee Kulick, MD, FACC, FSCAI

Daniel Lee Kulick, MD, FACC, FSCAI

Dr. Kulick received his undergraduate and medical degrees from the University of Southern California, School of Medicine. He performed his residency in internal medicine at the Harbor-University of California Los Angeles Medical Center and a fellowship in the section of cardiology at the Los Angeles County-University of Southern California Medical Center. He is board certified in Internal Medicine and Cardiology.

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Medical Editor:

Jay W. Marks, MD

Jay W. Marks, MD

Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

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Medical Editor:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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In this Article

• Heart attack facts
• What is a heart attack?
• What causes a heart attack?
• What are the symptoms of a heart attack?
• What are the complications of a heart attack?
• What are the risk factors for atherosclerosis and heart attack?
• How is a heart attack diagnosed?
• What is the treatment for heart attack?
• What about heart attacks in women?
• What are the risk factors for heart attack in women?
• What are the symptoms of heart attack in women and how is heart attack diagnosed?
• How is heart attack in women treated?
• What about hormone therapy and heart attack in women?
• What is new in heart attack?
• Patient Comments: Heart Attack - Treatments
• Patient Comments: Heart attack - Symptoms
• Heart Attack Index

Women are more likely to encounter delays in establishing the diagnosis of heart attack than men. This is in part because women tend to seek medical care later than men, and in part because diagnosing heart attacks in women can sometimes be more difficult than diagnosing heart attacks in men. The reasons include:

1. Women are more likely than men to have atypical heart attack symptoms such as:
   • neck and shoulder pain,
   • abdominal pain,
   • nausea,
   • vomiting,
   • fatigue, and
   • shortness of breath.
2. Silent heart attacks (heart attacks with little or no symptoms) are more common among women than among men.
3. Women have a higher occurrence than men of chest pain that is not caused by heart disease, for example chest pain from spasm of the esophagus.
4. Women are less likely than men to have the typical findings on the ECG that are necessary to diagnose a heart attack quickly.
5. Women are more likely than men to have angina (chest pain due to lack of blood supply to the heart muscle) that is caused by spasm of the coronary arteries or caused by disease of the smallest blood vessels (microvasculature disease). Cardiac catheterization with coronary angiograms (X-ray studies of the coronary arteries that are considered the most reliable tests for CAD) will reveal normal coronary arteries and therefore cannot be used to diagnose either of these two conditions.
6. Women are more likely to have misleading, or "false positive" noninvasive tests for CAD then men that don't disclose the arterial disease that is present.

Because of the atypical nature of symptoms and the occasional difficulties in diagnosing heart attacks in women, women are less likely to receive aggressive thrombolytic therapy or coronary angioplasty, and are more likely to receive it later than men. Women also are less likely to be admitted to a coronary care unit.