Changing the way we view women's heart attack symptoms

年轻女性心脏病发作的误诊率高于男性, and one key way to change that, researchers say, is to think differently about how symptoms can manifest.

几十年来，对女性的评估都是以男性为导向的. “心脏病学在采取平衡研究方法方面的历史性失败导致了对女性心脏病患者护理的根本缺陷，并使许多女性失去了生命," according to a 2019 editorial in the medical journal The Lancet.

Typically, 心脏病发作的诊断首先由医疗保健提供者按照一个程序来识别一组典型的常见症状. 无论是男性还是女性，心脏病发作的主要症状都是胸痛.

But a new study published in February in Circulation: Cardiovascular Quality and Outcomes 发现55岁以下的女性通常在症状组合上比男性有更多的变化，而不仅仅是个体症状的差异. Physicians have sometimes failed to relate these other, 不太明显的症状组合与心脏病发作有关，因此避免进行心脏病发作诊断.

最近越来越多的研究表明，女性心脏病发作的经历与男性不同. But Dr. John E. Brush Jr., the new study's lead author, 他说，他和他的同事是第一个深入研究个体患者的特定症状如何结合成独特的症状组合的人.

"As a physician, if you're looking at a woman, you need to think more expansively," said Brush, 诺福克东弗吉尼亚医学院的医学教授和执业心脏病专家. “她可能没有胸痛的典型特征组合, radiating pain down the arm, shortness of breath and sweating, which are often the examples given in textbooks."

事实上，心脏病发作的女性可能没有这些症状.

"In women, 我们必须扩大到包括颈部疼痛，有时只是头晕和恶心，感觉像胃灼热," said Dr. Jennifer H. Mieres, 诺斯韦尔健康中心护理公平中心高级副总裁，亨普斯特德霍夫斯特拉/诺斯韦尔扎克医学院心脏病学教授, New York. "Jaw, 背部和手臂疼痛可能是前来就诊的女性的唯一表现, and chest discomfort could come later."

Even then, 许多女性报告的胸部不适可能远没有男性心脏病发作时通常经历的那种剧烈疼痛，而且可能看起来不那么紧迫, experts said. 仅仅意识到女性的许多组合和更微妙的迹象可能是更快诊断和治疗的关键.

"Let's say you're at home and you have nausea, jaw pain and heartburn, and you're not thinking this could be a heart attack, even when you know you're at risk," said Mieres, an executive producer of the documentary film Ms. Diagnosed，重点关注妇女心血管疾病护理方面的不公平现象. “我们需要记住，女性的症状要广泛得多."

When Mieres says "we,她指的不仅是医疗保健专业人员——从急救人员到急诊室分诊护士再到医生——还包括女性, too.

"We see our patients as partners, and this calls for active participation in their own health," Mieres said. "Health is your most valuable asset. Why would you not do everything you could to protect it? When tax time comes around, 你不可能没有收据就去找会计，指望得到退款. You have to be an active participant in maintaining your health."

Dr. 国家心脏、肺和血液研究所的Nakela Cook在最近的一份报告中警告说 Circulation: Cardiovascular Quality and Outcomes editorial 新的思维方式应该支持而不是取代当前的思维方式.

“人们越来越多地认识到，女性比男性更有可能在(心脏病发作)时表现出胸痛或不适以外的一系列症状，这提高了患者的意识, 但也可能无意中淡化了胸痛是男性和女性最常见的症状这一信息," Cook wrote.

Brush said people at risk can take comfort knowing "most of the time, the diagnosis is not missed in either women or men."

With more awareness among medical professionals and female patients, he said, "most of the time" can continue to move toward "all of the time."

If you have questions or comments about this story, please email [email protected].