'It was not chest pain really, I can't explain it!' An exploratory study on the nature of symptoms experienced by women during their myocardial infarction.

AIMS AND OBJECTIVES: This study sought to explore the presenting nature of cardiac symptoms as experienced by women diagnosed with a myocardial infarction. The objectives were to use the participants' own words to gain a detailed understanding of how they perceived their evolving symptoms.

BACKGROUND: Women with coronary heart disease tend to delay seeking help despite experiencing symptoms. The classic hallmarks used to diagnose a myocardial infarction have been based on research primarily involving white middle-aged men with a focus on specific descriptions of chest pain. Whether these hallmarks apply to women in the same way as they apply to men is an area of increasing contention.

DESIGN: Using a purposive sample, a qualitative design was used to investigate the nature of cardiac symptoms experienced by women prior to and at the time of their myocardial infarction.

METHOD: Twelve women participated in semi-structured in-depth tape-recorded interviews conducted while they were in hospital.

RESULTS: Three interlinking themes emerged, which reflect a changing dynamic status in health, mediated by the perceived threat of individual symptoms. These included gradual awareness, not having pain in the chest and reactions to symptoms.

CONCLUSIONS: It would appear that symptom presentation and distribution amongst women may not follow the pattern traditionally associated with current understanding of a 'typical' myocardial infarction. These differences together with perceptions about their cardiac symptoms may influence their health-seeking behaviours.

RELEVANCE TO CLINICAL PRACTICE: Women with a myocardial infarction may present with non-specific chest symptoms, which are difficult to interpret or recognize by patients and health professionals alike. Skill in recording history and in performing a comprehensive assessment of initial and current symptoms will enable nurses to identify women with a differential diagnosis of chest pain readily. Additionally, to increase awareness of coronary heart disease, nurses must use any opportunity to educate women of all age groups.