Article Text


Adult nursing
Fatigue is an important potential symptom of myocardial infarction in women
  1. David Barrett
  1. Faculty of Health Sciences, University of Hull, Hull, UK
  1. Correspondence to Dr David Barrett, Faculty of Health Sciences, University of Hull, Hull HU6 7RX, UK; D.I.Barrett{at}

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Commentary on: Blakeman JR, Stapleton SJ. An integrative review of fatigue experienced by women before and during myocardial infarction. J Clin Nurs 2017; 27: 906-916

Implications for practice and research

  • Nurses must recognise that women may experience a range of symptoms other than chest pain, including fatigue, before or during myocardial infarction (MI).

  • More research is required into interventions that enhance the early presentation, assessment and treatment of women with MI.


Though mortality rates for coronary heart disease (CHD) have fallen over time due to improvements in prevention and management, the condition is still responsible for approximately one-third of adult deaths globally.1 As an acute manifestation of CHD, MI is a common cause of mortality and morbidity. Recognising the symptoms of MI is crucial, as early presentation, diagnosis and treatment improve patient outcomes. This review by Blakeman and Stapleton2 explored a symptom not always viewed as a ‘typical’ indicator of MI: fatigue. Focusing on the experiences of women with MI, the authors sought to capture the current evidence base related to fatigue as a prodromal (occurring in the weeks and months before MI) or acute MI symptom.


The study was an integrative review of literature based on a systematic approach to searching, appraising and evaluating evidence.2 Accessing a range of databases (including CINAHL and PubMed), the authors searched for the literature related to fatigue as a prodromal or acute symptom of MI. The quality of evidence was appraised using the John Hopkins Nursing Evidence-based Practice Model, and a constant comparative approach to analysis was adopted. The Theory of Unpleasant Symptoms, which identifies four dimensions of symptoms (distress, timing, intensity and quality)3 was used to frame the findings.


Twenty-one articles were included in the review, demonstrating a range of qualitative, quantitative and mixed-methods approaches. The findings suggested that fatigue was the most common prodromal symptom of MI in women and was also frequently reported as one symptom of acute MI. The authors identified a number of complexities in conceptualising fatigue as a symptom of MI in women, including different interpretations of terminology (‘fatigue’ could encompass issues such as weakness, tiredness and cognitive change) and difficulties in quantifying the severity of symptoms. Nonetheless, the work concluded that healthcare practitioners needed to recognise the importance of fatigue as a potential symptom of imminent or acute MI in women.


The study provides a timely, systematic and comprehensive review of the current evidence base related to fatigue as a prodromal or acute symptom of MI in women. However, it also provides a welcome addition to the broader literature surrounding the experiences and outcomes of women who present with MI.

Though MI is less prevalent in women than in men, clinical outcomes are worse, with higher levels of mortality (in-hospital and at 12 months) and morbidity (including development of heart failure).1 4 Some of these differences in outcomes stem from women being less likely to receive evidence-based treatment (pharmacological or interventional) than men. However, the symptoms experienced by women during MI also contribute. There still exists a perception that a ‘typical’ MI is characterised by central, crushing chest pain (sometimes radiating to left arm and jaw), despite approximately one-third of women not reporting chest pain during acute MI, instead experiencing ‘atypical’ symptoms such as fatigue, dizziness and nausea.5 This can cause a delay in presentation of women to healthcare services and may impact on the speed of diagnosis. Given the well-established link between the time taken to treat MI and the severity of myocardial damage (colloquially known as ‘time is muscle’), delays caused by a failure to recognise and diagnose MI have a negative impact on patient outcomes in women.4

To address this, there needs to be greater awareness among the public and practitioners of the different ways in which MI can present, from chest pain through to less specific symptoms, such as fatigue, nausea and dizziness. There is a responsibility for nurses to provide education to patients with CHD and their carers, enhancing recognition of MI symptoms and promoting earlier presentation to healthcare services. This, coupled with holistic and comprehensive patient assessment, will facilitate swifter identification, diagnosis and management of MI, leading to improved outcomes for both women and men.


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  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

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