Acute myocardial infarction in women.

Although CHD is the leading cause of death in women, little is known about their response to and recovery from an acute MI. The medical and nursing care offered to women following an MI is based primarily on research studies of men. Few studies have included only women, and those that have compared women and men are limited by sample sizes that are too small for meaningful comparisons and study variables that reflect men's concerns (e.g., specific risk factors or return to work issues). Women's cardiovascular anatomy and physiology differ somewhat from men's. Women average smaller chests, hearts, and coronary artery vessel diameters and different body fat distributions. Their cardiovascular systems are designed to adapt to the extraordinary demands of pregnancy and childbirth and do so by modifying diastolic, rather than systolic, function. Similar physiologic changes are often seen in response to exercise. Women's higher levels of estrogen and progesterone influence lipid metabolism and hormone receptor activity. Thus, diagnostic tests that are based on research with men (e.g., ECGs and exercise stress tests), show more false-positive and false-negative results in women. Additionally, therapeutic interventions (e.g., PTCA and CABG) that were developed for men have been less effective for women. CHD is apparently expressed differently in women. Diabetes mellitus is a strong, independent risk factor for CHD in women and results in a risk similar to that of nondiabetic men. More women present with angina as an initial manifestation of CHD than with MI and rarely have sudden cardiac death. Women experience more complications than men and a higher mortality following acute MI. They derive less benefit from medical or surgical therapy and experience more side effects. Many aspects of women's response to acute MI reflect gender rather than biologic differences. Women's worlds, the sociocultural contexts within which they live, and their activities are qualitatively different from men's. The nursing care offered to women should be based on sound scientific rationale that responds to these unique experiences and concerns.