Home and Community Care Digest

Home and Community Care Digest 8(3) November -0001

Cardiac pain in women: A stranger unveiled


Misunderstanding of warning signs of acute myocardial infarction and angina in women leads to delayed treatment in the majority of women. This review of qualitative studies on how women experience cardiac pain revealed that women and health professionals misunderstand warning signs and risks of coronary heart disease leading to delayed treatment. Nurses and other health professionals need to focus on the completion of a thorough assessment, their ability to identify women at risk, and health promotion strategies that target cardiac pain recognition in women.
Background: Gender differences in how cardiac pain is viewed and experienced can lead to underdiagnoses, misdiagnoses, and delayed treatment of symptoms associated with coronary heart disease (CHD) in women. Despite being the main cause of mortality of women in Canada, the medical community has assumed CHD to be a benign problem in women. Coronary heart disease escalates in women after menopause, and 90% of deaths in women from acute myocardial infarction (AMI) occur after age 65. Women are five times more likely than men to have normal coronary arteries, with complaints of chest pain, and often experience cardiac pain differently from men, thereby complicating the recognition of cardiac pain by health practitioners. The author conducted a review of the literature that explores the experiences of women with cardiac pain.

Methods: In a literature review, qualitative studies from 1995 to 2007 that explored cardiac pain for acute myocardial infarction, angina, congestive heart failure and pain post-treatment were reviewed. Of 221 studies, 6 studies met the inclusion criteria of being qualitative and focused on women's experience of cardiac pain. Main concepts, participants and themes were included in a summary table of the studies.

Findings: The six studies reviewed by the author used qualitative methods to examine the pain experience of women from Australia, the United States and England. Two focused on interpretation of pain, two on symptoms of AMI, one on illness perception following AMI and one on the lived experiences of women with angina. Five themes were identified. (1) Prodromal and acute pain symptoms can vary widely (from general chest discomfort and include left breast pain, fatigue, shoulder blade discomfort, arm heaviness or ache, chest sensations, sudden shortness of breath, hot or flushed, and sweating). (2) Most women did experience prodromal (warning) signs, but failed to seek medical treatment because of the lack of recognition of cardiac pain and risk factors. (3) Living with CHD is a process involving continual reorganizing of the cardiac pain experience. (4) There is a disconnect between the approach of women and practitioners to CHD and (5) Gender differences in cardiac pain experience were key factors influencing access to appropriate treatment. Cardiac disease is prevalent in women of all ages and in all cultures ranging from 27 to 82, with mean age 66.

Conclusions: The author concluded that misconceptions of "typical heart pain" have caused lack of recognition, diagnosis and treatment of CHD in women. Research and education need to increase awareness that cardiac pain differs in women. Healthcare practitioners and leaders need to be cognizant of women's experience of chest pain to dispel assumptions that CHD is benign in women. Moreover, health promotion strategies need to target: (1) women's recognition of cardiac pain and risk factors, (2) barriers to treatment seeking behavior, and (3) impact of CHD on women's quality of life. Nurses also need to promote an interdisciplinary approach to caring for women with CHD.


O'Keefe-McCarthy, S. Women's Experience of Cardiac Pain: A Review of the Literature. Canadian Journal of Cardiovascular Nursing, 2009; 18(3): 18-25.


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