women and heart disease: triage criteria symptoms versus reality
TRANSCRIPT
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Women and Heart Disease:Triage Criteria
Symptoms versus Reality
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Mars vs. Venus
When it comes to cardiovascular disease,Women and Men ARE Different !
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Heart Disease is the #1 Killer of Women
• Heart disease is the leading cause of death of American women
• 8,000,000 American women are currently living with heart disease
• 435,000 American women have heart attacks each year with an average age of 70.4 years
• Women are more likely than men to have a heart attack without chest pain
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The Need for Prevention in Women
• 9,000 US women younger than 45 sustain a heart attack each year.
• “Thus the priority for coronary prevention is substantial for women of all ages.”
• Mortality associated with acute MI among women younger than 65 years is almost twice as high among men.
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• Women tend to get heart disease about 10 years later than men and are more likely to have coexisting chronic illnesses
• Research also shows that women may not be diagnosed or treated as aggressively as men, and their symptoms may be very different from those of men having a heart attack
Coronary Heart Disease in Women
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Coronary Heart Disease in Women
Presentation and differences from men:
• 2/3 of women who die suddenly have NO previously recognized symptoms.
• Women are more prone to non-cardiac chest pain…..
• In fact they may experience little or no squeezing chest pain in the center of the chest with an MI (as seen on “ER”).
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Case Study: 86 Y/O woman
• Presented to ED at 4pm with back and shoulder pain, nausea, anxiety and feeling like she “can’t relax”
• Stated woke at 3am “sweating, nauseated and anxious”
• DENIED ANY CHEST PAIN
• Did not present in acute distress
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Case Study: continued
• Triaged within 10 minutes
• EKG not done for another 40 minutes
• EKG showed STEMI in the inferior leads
• At that point, Code STEMI was called and patient taken emergently to the Cath lab.
• A 50 minute delay in diagnosis due to atypical symptoms.
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Nationally: The Problem is AWARENESS
Perception:• 67% of women are
knowledgeable that chest pain can be heart disease
• But, less than 10% are knowledgeable that shortness of breath, nausea, indigestion can be heart disease
Reality:• Chest pain is the
presenting symptom in less than 50% of women
• Almost half of MIs in women present with shortness of breath, nausea, sleep disturbance, fatigue and shoulder pain
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Symptoms in Men vs. Women
Men WomenChest pain Neck/shoulder pain
Shortness of breath Nausea/vomiting
Sweating Fatigue
Pain in one or both arms Indigestion
Jaw Pain Dizziness
Lightheadedness
Shortness of breath
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Women’s Common Pre-heart attack symptoms :
Women are more likely to have:
• Unusual Fatigue– 70%
• Sleep disturbances—48%
• Shortness of breath– 42%
• Indigestion—39%
• Anxiety-35%
• Cold sweat rather than a hot sweat—39%
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Women’s Major Symptoms during a Heart Attack
• Shortness of breath– 58%
• Weakness--55%
• Unusual Fatigue– 43%
• Cold Sweat– 39%
• Dizziness– 39%
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Not so straightforward
• Because of these atypical symptoms, women seek medical care later than men and are more likely to be misdiagnosed.
• Women presenting with MI and Coronary artery disease are more likely to be older, have a history of diabetes, high blood pressure, high cholesterol, CHF, and unstable angina than male counterparts. (JAm Coll Cardiol 1997;29).
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Misperceptions and Missed Opportunities Leading to Unequal Diagnosis and Treatment
• Women are less likely to have an EKG or be admitted to the telemetry floors.
• Women are under-diagnosed and can therefore get a false sense of security.
• Less aspirin, beta-blockers, cholesterol meds, antiarrhythmic treatment, cardiac cath, balloon angioplasty, and cardiac bypass surgery are prescribed for women
• Women are less likely to enroll in cardiac rehabilitation after an MI or bypass surgery.
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Conclusion
Women presenting with atypical symptoms of chest pain should be triaged just like a man presenting with classic symptoms of chest pain
• Delay of triage due to atypical symptoms may lead to a delay in treatment resulting in significant injury to the patient