LAST week we began looking at coronary artery disease (CAD) in the young female patient and examined the characteristics of young females with heart attack, the outcome when young female patients present with heart attacks and the causes of heart attacks in the young female patient.

This week we continue by exploring how young females oresent with heart attack and how they can reduce the risk of a heart attack.

How do young female patients with heart attack present?

Like older patients the most common complaint is chest pain however the incidence of chest pain is less when compared to older women and men of similar ages. More importantly is the fact that one in five young women who present with heart attack ascribe their symptoms to anxiety or stress and may delay seeking medical attention. More worrisome is that when young female patients present to doctors with symptoms suggestive of heart disease or heart attack, many are not properly attended to as there is a higher tendency among providers to ascribe those complaints to anxiety , stress or depression.,

How can young females reduce the risk of heart attack?

It has been standard teaching in cardiology that young females who have not undergone menopause are at low risk of heart attack. While this population still represents a minority of patients it is important to note that heart attacks in young people are increasing in frequency and young females represent an increasing percentage of heart attacks. The reasons for this are complex but a significant factor is the increase in chronic diseases that are occurring at younger ages. High income, low- and middle-income countries are all experiencing epidemics of obesity, hypertension, and diabetes. Life for many has become increasingly sedentary with poor dietary habits and adverse risk factors including smoking, drug, and alcohol abuse. Improved lifestyle measures and aggressive management of chronic disease thus form the foundation of management.

Education of the medical establishment and the general population is important. We have recently written several articles about the importance of urgent evaluation of chest pain, but we also need to emphasise that a young person is not necessarily at low risk for heart attack particularly especially if multiple co-morbidities are present. We feel obliged to state it here yet again that every chest pain is an emergency until proven otherwise, and this holds true for both young and old and for both men and women. All chest pains therefore must be evaluated with utmost urgency irrespective of the gender, age, or risk profile of the patient. No exceptions. It is only after proper and appropriate evaluation by a competent physician can an informed classification be made as to the nature of the symptom. Within the emergency medical system, increased attention should be paid to the factors that result in delayed and suboptimal management of young patients generally and young female patients in particular. After discharge, patients will need long term cardiology follow-up, continued medical management and risk factor modification.

Dr Ernest Madu, MD, FACC and Dr Paul Edwards, MD, FACC are consultant cardiologists for Heart Institute of the Caribbean (HIC) and HIC Heart Hospital. HIC is the regional centre of excellence for cardiovascular care in the English-speaking Caribbean and has pioneered a transformation in the way cardiovascular care is delivered in the region. HIC Heart Hospital is registered by the Ministry of Health and Wellness and is the only heart hospital in Jamaica. Correspondence to info@caribbeanheart.com or call 876-906-2107