Women’s experiences of myocardial infarction were described in terms of gradual onset, not having chest pain, and responding to symptoms
J W Albarran
Correspondence to: Mr J W Albarran, University of the West of England, Bristol, UK;
How do women experience symptoms before and during myocardial infarction (MI)?
A purposive sample of 12 women ⩾18 years of age (age range 48–78 y), who had an MI (increase in serum troponin >0.1 ng/l, with or without ST-segment elevation on the electrocardiogram) and were free of discomfort for 24 hours after MI. Exclusion criteria were inability to speak English, clinical instability, and cognitive problems.
Women participated in 30–45 minute semi-structured interviews, which addressed their thoughts and perceptions of the onset of their symptoms. The term “chest pain” was not included in any questions unless participants used it. Interviews were tape recorded and transcribed verbatim.
3 themes reflected the experiences of women who had an MI. (1) Gradual awareness. Women noticed a series of symptoms in the previous weeks or hours or as part of the acute MI episode. Breathlessness, sometimes associated with physical exertion, was a common primary symptom. Other symptoms included heaviness across the chest, indigestion, being more exhausted than usual, and difficulties sleeping. After women became aware of symptoms, they often attributed non-specific symptoms to chronic conditions, ageing, body weight, hormone therapy, smoking, indigestion, or lack of exercise. (2) Not having pain in the chest. Reported symptoms were notable in terms of the lack of a uniform pattern. Symptoms were noted in various areas of the body, including chest, back, neck, upper arms, hands, and stomach. The nature of sensations also varied, with descriptions such as pushing or a feeling of heaviness or numbness, sometimes extending to the wrist, hand, and fingers. Most women described some type of sensation in the chest. 5 initially reported chest pain, typically in the middle of the chest, as the reason for admission. However, upon further probing, 3 women revised their initial response, saying, for example “I wouldn’t say it was pain…You know my pain was different…It was a cramp, more like stiffness different from what you would expect.” Women experienced periodic and/or progressive discomfort, and each episode was assessed based on preconceptions (eg, discomfort was described as a “blockage” in her chest, “like your breakfast hadn’t gone down”). 10 women reported nausea, often with an abrupt onset, during the acute episode. (3) Responding to symptoms. Many women did not seek medical attention because of the odd and intermittent nature of their symptoms. Usually, however, there was a point where women recognised that they were seriously unwell. Women’s beliefs about their health status (eg, being fit and healthy) affected decisions to seek medical care. Even women with chronic health conditions such as hypertension, diabetes, or a family history of heart disease did not identify these as risk factors for MI and were shocked at the diagnosis.
The experiences of women who had a myocardial infarction were reflected in 3 themes: gradual awareness of symptoms, such as breathlessness; not having pain in the chest; and responding to symptoms (deciding to seek medical care).
Albarran JW, Clarke BA, Crawford J. ‘It was not chest pain really, I can’t explain it!’ An exploratory study on the nature of symptoms experienced by women during their myocardial infarction. J Clin Nurs 2007;16:1292–301.
The study by Albarran et al sought to identify how women perceived their symptoms related to MI. The findings support what is now well established knowledge: namely, that women can have symptoms that are different from those thought to be “typical” of MI. The value of the findings lies not in the confirmation that symptoms of MI differ between men and women but in shedding light on why women still fail to associate these symptoms with a cardiac problem and the underlying gender bias in cardiac care, which continues to affect women’s access to timely cardiac care. A common symptomatology could not be established across the study sample. However, it appears that both women and their health professionals tended to frame symptoms within the context of a typical MI. Given that the symptoms are only atypical because they are compared with those of men, it is questionable whether continued use of this terminology in practice or in the literature can create conditions in which women’s MI symptoms can be better understood. Participants’ reports suggest that they and their health professionals tended to label women’s symptoms as “chest pain” even when chest pain was not experienced. It appears that “chest pain” has been adopted by women and their health providers as a label for a symptom cluster associated with typical MI despite knowledge that women’s symptoms may be different. The varied symptomatology of women in this study and the entrenched gender bias reflected in labels used to describe women’s symptoms present challenges for the public and for health professionals to recognise and treat MI in women. The findings point to the need for future studies to explore women’s symptom experiences in relation to known risk factors, ST-segment elevation MI and non–ST-segment elevation MI. Understanding if and how symptoms differ among these subgroups could help to further explain gender differences in symptom experience, presentation, and subsequent triaging and care by health professionals.