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acute coronary syndrome, myocardial infarction, symptoms, treatment delay, women



  1. Davis, Leslie L. PhD, RN, ANP-BC, FAANP, FPCNA, FAHA


Background: Most studies show that women with symptoms of acute coronary syndrome (ACS) delay seeking care longer than men do. Contributing factors include women being more likely to experience diverse symptoms, to experience symptoms that do not match preexisting symptom expectations, to interpret symptoms as noncardiac, and to minimize symptoms until they become incapacitating.


Objective: The aim of the study is to identify factors influencing women's ability to recognize and accurately interpret symptoms of suspected ACS.


Methods: This qualitative study used in-depth interviews with 18 women diagnosed with ACS to determine how they recognized, interpreted, and acted on symptoms. An interview guide developed from the author's initial research was used to provide structure for the process.


Results: All of the women went through a process of recognizing and interpreting their symptoms. Eight women had symptoms arise abruptly. Most of these women recognized a change immediately, "knew" to go for treatment, and did so quickly. Three women had vague symptoms that started slowly, converting unexpectedly to intense symptoms prompting them to seek care urgently. The remaining 7 women had evolving symptoms, were more likely to interpret symptoms as unrelated to their heart, and avoided disclosing symptoms to others. Despite recognizing that the situation may be serious, women with evolving symptoms adopted a wait-and-see approach.


Conclusion: Women with less severe, intermittent, or evolving symptoms are at increased risk for delayed presentation, diagnosis, and treatment for ACS. These women should be targeted for educational and behavioral interventions.