Patricia B. Crane

Challenging the rules: Women's prodromal and acute symptoms of myocardial infarction

In this qualitative study the researcher identified symptoms women experienced prior to and during an acute myocardial infarction (AMI). The purposive nonprobability sample for this descriptive naturalistic study consisted of 40 women. Using content analysis and constant comparison, the researcher identified specific symptoms and grouped them according to time of occurrence, prodromal and acute. Thirty-seven women experienced prodromal symptoms, beginning from a few weeks to 2 years prior to their AMI and ranging from 0 to 11 symptoms per woman. The most frequent prodromal symptoms were unusual fatigue (n = 27), discomfort in the shoulder blade area (n = 21), and chest sensations (n = 20), whereas the most frequent acute symptoms were chest sensations (n = 26), shortness of breath (n = 22), feeling hot and flushed (n = 21), and unusual fatigue (n = 18). Only 11 women experienced severe pain during their AMI. Conclusions of this study are threefold: (a) women identified classic and unique symptoms of AMI, which challenge the content of current educational literature; (b) women experienced a gradual progression of number and severity of AMI symptoms; and (c) women need sufficient time to recognize their prodromal symptoms of their AMI.

Do you know them when you see them? Women's prodromal and acute symptoms of myocardial infarction.

This study described womens prodromal and acute symptoms associated with myocardial infarction (MI) based on interviews with 76 women who had experienced an MI in the previous year. Sixty-eight women experienced prodromal symptoms including unusual fatigue (70%), shortness of breath (53%), and pain in the shoulder blade/upper back (47%). All women experienced acute symptoms including chest pain/discomfort (90%), unusual fatigue (59%), shortness of breath (59%), and shoulder blade/upper back discomfort (42%). Although women in this study reported numerous prodromal symptoms, none had received a new diagnosis of coronary heart disease (CHD) prior to MI. Practitioners must develop an awareness of and a more comprehensive approach to treating women at risk for CHD. Further research to elucidate prodromal and acute symptom clusters is needed to assist practitioners in early diagnosis of CHD in women.

Development of the McSweeney acute and prodromal myocardial infarction symptom survey.

Background/Objectives:Coronary heart disease (CHD) is the number one cause of death in women, yet, little is known about womens symptoms. Early symptom recognition of CHD in women is essential but most instruments do not assess both prodromal and acute CHD symptoms. Our aims were to develop an instrument validly describing womens prodromal and acute symptoms of myocardial infarction and to establish reliability of the instrument, the McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey (MAPMISS). Methods:Four studies contributed to the content validity and reliability of this instrument. Two qualitative studies provided the list of symptoms that were confirmed in study 3. The resulting instrument assesses 37 acute and 33 prodromal symptoms. In study 4, 90 women were retested 7 to 14 days after their initial survey. We used the kappa statistic to assess agreement across administrations. Results:The women added no new symptoms to the MAPMISS. The average kappa of acute symptoms was 0.52 and 0.49 for prodromal. Next we calculated a weighted score. The mean acute score for time 1 was 19.4 (SD = 14.43); time 2 was 12.4 (SD = 8.79) with Pearson correlation indicating stability (r = .84; P < .01). The mean prodromal score at time 1 was 23.80 (SD = 24.24); time 2 was 26.79 (SD = 30.52) with a Pearson correlation of r = .72; P < .01. Conclusions:The tool is comprehensive, has high content validity, and acceptable test-retest reliability. Low kappas were related to few women having those symptoms. The symptom scores remained stable across administrations.

Racial Differences in Women’s Prodromal and Acute Symptoms of Myocardial Infarction

BACKGROUND Minority women, especially black and Hispanic women, have higher rates of coronary heart disease and resulting disability and death than do white women. A lack of knowledge of minority womens symptoms of coronary heart disease may contribute to these disparities. OBJECTIVE To compare black, Hispanic, and white womens prodromal and acute symptoms of myocardial infarction. METHODS In total, 545 black, 539 white, and 186 Hispanic women without cognitive impairment at 15 sites were retrospectively surveyed by telephone after myocardial infarction. With general linear models and controls for cardiovascular risk factors, symptom severity and frequency were compared among racial groups. Logistic regression models were used to examine individual prodromal or acute symptoms by race, with adjustments for cardiovascular risk factors. RESULTS Among the women, 96% reported prodromal symptoms. Unusual fatigue (73%) and sleep disturbance (50%) were the most frequent. Eighteen symptoms differed significantly by race (P<.01); blacks reported higher frequencies of 10 symptoms than did Hispanics or whites. Thirty-six percent reported prodromal chest discomfort; Hispanics reported more pain/discomfort symptoms than did black or white women. Minority women reported more acute symptoms (P < .01). The most frequent symptom, regardless of race, was shortness of breath (63%); 22 symptoms differed by race (P <.01). In total, 28% of Hispanic, 38% of black, and 42% of white women reported no chest pain/discomfort. CONCLUSIONS Prodromal and acute symptoms of myocardial infarction differed significantly according to race. Racial descriptions of womens prodromal and acute symptoms should assist providers in interpreting womens symptoms.

An Innovative Strategy to Enhance NEW FACULTY SUCCESS

Faculty stress is a factor in the current shortage of nursing faculty. New faculty members in schools of nursing are subject to stress from many sources. This article reports on an innovative strategy that decreases stress for new faculty while facilitating faculty tenure success.

Cardiovascular risks and physical activity in middle-aged and elderly African-American women.

Cardiovascular disease rates are higher in African American women and they have more cardiovascular risk factors than other groups. Although one of the most important cardiovascular risk reduction behaviors is physical activity, few studies have focused on African American womens cardiovascular risk and physical activity. Therefore, the aims of this descriptive pilot study were to describe modifiable cardiovascular risks and to explore physical activity, as measured by pedometer steps, in younger (n = 22; aged 21-45 years) and older (n = 22; aged 46-75 years) community-dwelling African American women. The total number of pedometer steps recorded in 3 days ranged from 1,153 to 52,742. Day 1 steps were significantly different than day 2 and day 3 steps across the sample (F = 5.30, df = 1, P < .05). Risk factors were similar across the age groups. There was no relationship between the 3-day total or average number of daily steps and cardiovascular risks. Thus, interventions may be used in both age groups, with modifications for cohort effects of approach and health status. Given the disparities in cardiovascular disease and the Healthy People 2010 national health objectives, it is important to continue a variety of efforts to assist adult women of all ages to increase their physical activity and to decrease other CVD risks.

Exploring Polypharmacy in Elderly Women after Myocardial Infarction

The aims of the study were to: (a) examine the number, absolute volume, and type of daily medications older women were taking 6 to 12 months post-myocardial infarction (MI); (b) describe the financial burden of cardiac medications; and (c) examine the relationship of age, education, and income to the number of medications. An analysis of a cross-sectional descriptive study of women >65 years of age who were post-MI was used. Most (89%; N = 83) were taking at least one cardiac medication, costs per day varied (

CHOOSING A PUBLICATION VENUE

0.13–

Predictors of Depression in Black Women with Hypertension

6.75), and total number of pills taken per day was 1 to 19. Age, education, and income did not explain the number of medications. Consideration of the financial burden of medications is important to increase compliance and foster secondary prevention in older women.

Beta-blocker medication usage in older women after myocardial infarction.

The choice of a venue for publication of a manuscript is rarely a clear-cut decision. Several factors should be considered in this decision, such as the audience for whom you are writing, the topic of the manuscript, the purposes for which you are writing, and the journal guidelines. These factors may vary in importance to the author. Examining each factor and plotting the importance visually on a checklist will assist the author in making the decision about where a manuscript should be submitted so that the article will have the desired impact.