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Unusual Fatigue May Be Warning Symptom Of Heart
Attack In Women
Nov. 5, 2003 – 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 the rapid access issue of 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," said Jean C. McSweeney, Ph.D., R.N., lead author and a
professor in the College of Nursing at the University of Arkansas for
Medical Sciences in Little Rock.
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 black 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 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. 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
and 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, 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 McSweeney and colleagues 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.
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.
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,"
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 and 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," 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.
Co-authors are Marisue Cody, Ph.D., R.N.; Patricia
O'Sullivan, Ed.D.; Karen Elberson, Ph.D., R.N.; Debra K. Moser, DNSc,
R.N. and Bonnie J. Garvin, Ph.D., R.N. The National Institute of Nursing
Research, part of the National Institute of Health, funded the study.
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