Doctors more likely to mistake heart attack signs for stress in WOMEN

Doctors are more likely to mistake heart attack symptoms for stress or anxiety in WOMEN than in men, study warns

  • Experts from Spain studied the experience of 41,828 patients with chest pain
  • They looked at how rapidly patients went to hospital and their initial diagnosis
  • Women with heart-related problems were nearly twice as likely be misdiagnosed
  •  Furthermore, women were also more likely to take longer to seek medical help

Women experiencing heart attacks are more likely than men to have their symptoms of chest pain misdiagnosed by doctors as anxiety or stress, a study has warned.

Researchers from Spain analysed the treatment of 41,828 patients who were admitted to hospital with chest pain and compared the treatment they received.

Women were almost twice as likely as men to have a case of acute coronary syndrome — including a heart attack — be initially misdiagnosed.

But doctors weren’t the only ones misjudging circumstances, the team found, with women being more likely than men to wait more than 12 hours before seeking help.

A study from 2014, meanwhile, found that women with heart attacks are also more likely to have to wait longer to be examined in hospitals than men are. 

Women experiencing heart attacks are more likely than men to have their symptom of chest pain misdiagnosed by doctors as anxiety or stress, a study has warned (stock image)

‘Our findings suggest a gender gap in the first evaluation of chest pain, with the likelihood of heart attack being underestimated in women,’ said paper author Gemma Martinez-Nadal of the Hospital Clinic of Barcelona, Spain.

‘The low suspicion of heart attack occurs in both women themselves and in physicians, leading to higher risks of late diagnosis and misdiagnosis.’

In their study, Dr Martinez-Nadal and colleagues studied the experiences of a total of 41,828 patients who were admitted to a hospital emergency department with chest pain between the years 2008 and 2019.

Of the patients, 42 per cent were women, and the median age was 65 years for the women and 59 for the men. 

For each subject, the researchers collected information on their risk factors for heart attack — including whether or not they were obese or had high blood pressure — and the initial diagnosis of the physician handling the case. 

‘We had the first impression of the doctor as to whether the chest pain had a coronary cause or another origin, such as anxiety or a musculoskeletal complaint,’ Dr Martinez-Nadal explained.

Such first impressions are recorded prior to examinations like blood tests, and are instead given based on the patient’s clinical history, a physical examination and an electrocardiogram (ECG) measurement of heart activity. 

The researchers found that women were significantly more likely to present themselves at the hospital more than 12 hours after the onset of chest pain — this occurred in 41 per cent of women compared to 37 per cent of the men. 

‘This is worrying since chest pain is the main symptom of reduced blood flow to the heart — an ‘ischaemia’ — because an artery has narrowed,’ said Dr Martinez-Nadal. 

‘It can lead to a myocardial infarction which needs rapid treatment,’ she added — referring to the condition more commonly known as a heart attack.

‘In the doctor’s first impression, women were more likely than men to be suspected of a non-ischaemic problem,’ said Dr Martinez-Nadal. Pictured, a patient with chest pain (stock image)

The team found that the physicians were significantly more likely to attribute chest pain to acute coronary syndrome — an umbrella term for condition like heart attacks that involve a reduced blood flow to the heart — if the patient was a man.

Specifically, in the 93 per cent of cases in which the ECG was unable to provide a definitive diagnoses, the doctors suspected acute coronary syndrome in 44.5 per cent of the men but only 39 per cent of the women. 

Moreover, this trend was maintained regardless of the number of heart attack risk factors the patients had or whether they exhibit typically indicative chest pains.

Acute coronary syndrome was initially misdiagnosed in 5 per cent of women, but only 8 per cent of men.

‘In the doctor’s first impression, women were more likely than men to be suspected of a non-ischaemic problem,’ said Dr Martinez-Nadal.

‘Risk factors like hypertension and smoking should instil a higher suspicion of possible ischaemia in patients with chest pain.’ 

‘But we observed that women with risk factors were still less likely than men to be classified as “probable ischaemia”.’ 

‘Heart attack has traditionally been considered a male disease, and has been understudied, underdiagnosed, and undertreated in women, who may attribute symptoms to stress or anxiety,’ concluded Dr Martinez-Nadal.

‘Both women and men with chest pain should seek medical help urgently.’

The full findings of the study are being presented at the European Society of Cardiology’s Acute CardioVascular Care 2021 congress, which is being held virtually from March 13–14, 2021.


Figures suggest there are 200,000 hospital visits because of heart attacks in the UK each year, while there are around 800,000 annually in the US.

A heart attack, known medically as a myocardial infarction, occurs when the supply of blood to the heart is suddenly blocked.

Symptoms include chest pain, shortness of breath, and feeling weak and anxious.

Heart attacks are commonly caused by coronary heart disease, which can be brought on by smoking, high blood pressure and diabetes.

Treatment is usually medication to dissolve blots clots or surgery to remove the blockage.

Reduce your risk by not smoking, exercising regularly and drinking in moderation.

Heart attacks are different to a cardiac arrest, which occurs when the heart suddenly stops pumping blood around the body, usually due to a problem with electrical signals in the organ.

Source: NHS Choices

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