What are the symptoms of heart attack in women and how is heart attack diagnosed?

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:

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.

1. Silent heart attacks (heart attacks with little or no symptoms) are more common among women than among men.
2. 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.
3. Women are less likely than men to have the typical findings on the ECG that are necessary to diagnose a heart attack quickly.
   
4. 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.
   
5. Women are more likely to have misleading, or "false positive" noninvasive tests for CAD then men.
   

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.