Heart Attacks: Women Are Different Than Men

Heart Disease (Coronary Artery Disease) Slideshow

Significant differences exist between men and women in the clinical presentation of heart attack and in the response to treatment. Women having a heart attack are likely to be older and have a higher incidence of high blood pressure, diabetes, high cholesterol, and congestive heart failure than do men. They are less likely to be smokers. The symptoms of acute heart attack are slightly different in women. Women are more likely to have neck and shoulder pain, abdominal pain, nausea, vomiting, fatigue, and shortness of breath in addition to chest pain. Silent heart attacks are more common in women. Often, because of these atypical symptoms, women seek medical care later than do men.

Even after arrival at the hospital, women may encounter delay in establishing the diagnosis of heart attack. Women are somewhat less likely than men to have the typical EKG findings to diagnose acute heart attack. Women with heart attack are generally more ill than are men. Despite this, women are paradoxically less likely to receive aggressive clot-busting treatments (thrombolytic therapy described below) and are more likely to receive it later than do men. Women are also less likely to be admitted to a coronary care unit.

There are conflicting data on whether women with acute heart attack are more or less likely to undergo cardiac angiography. Once angiography is performed, however, women are equally as likely as men to undergo angioplasty or CABG. In-hospital complications of heart attack (stroke, shock, myocardial rupture, recurrent chest pain) are similar in women and men. In-hospital mortality after heart attack is slightly higher in women. Mortality 1 to 3 years after hospital discharge is similar, and possibly slightly better, in women. Following discharge from the hospital, women are less likely to be scheduled for exercise testing or cardiac rehabilitation.

Drugs that dissolve coronary blood clots in a heart attack, called thrombolytic therapy, have been shown to reduce mortality similarly in men and women. However, the complication rate of stroke is higher in women. Emergency angioplasty for acute heart attack is as effective in women as in men. Following hospital discharge after heart attack, medical treatment carries different benefits in men and women. Aspirin has not been definitively proven to prevent repeat heart attack in women. Men may experience a greater benefit than women from angiotensin-converting enzyme (ACE) inhibitors after heart attack. Beta blockers substantially improve survival after heart attack in women, possibly a greater benefit than in men. Despite this, women are less likely to be prescribed a beta blocker.