Women’s Early Warning Symptoms of Acute Myocardial Infarction

Background— Data remain sparse on women’s prodromal symptoms before acute myocardial infarction (AMI). This study describes prodromal and AMI symptoms in women. Methods and Results— Participants were 515 women diagnosed with AMI from 5 sites. Using the McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey, we surveyed them 4 to 6 months after discharge, asking about symptoms, comorbidities, and demographic characteristics. Women were predominantly white (93%), high school educated (54.8%), and older (mean age, 66±12), with 95% (n=489) reporting prodromal symptoms. The most frequent prodromal symptoms experienced more than 1 month before AMI were unusual fatigue (70.7%), sleep disturbance (47.8%), and shortness of breath (42.1%). Only 29.7% reported chest discomfort, a hallmark symptom in men. The most frequent acute symptoms were shortness of breath (57.9%), weakness (54.8%), and fatigue (42.9%). Acute chest pain was absent in 43%. Women had more acute (mean, 7.3±4.8; range, 0 to 29) than prodromal (mean, 5.71±4.36; range, 0 to 25) symptoms. The average prodromal score, symptom weighted by frequency and intensity, was 58.5±52.7, whereas the average acute score, symptom weighted by intensity, was 16.5±12.1. These 2 scores were correlated ( r =0.61, P <0.001). Women with more prodromal symptoms experienced more acute symptoms. After controlling for risk factors, prodromal scores accounted for 33.2% of acute symptomatology. Conclusions— Most women have prodromal symptoms before AMI. It remains unknown whether prodromal symptoms are predictive of future events.