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Access Type

WSU Access

Date of Award

January 2018

Degree Type


Degree Name




First Advisor

Hossein N. Yarandi


Aim: The purpose of this study was to identify MI-related symptoms in Middle Eastern women, and to explore the relationship between delay in seeking medical help for MI-related symptoms, responses to these symptoms, and knowledge about prodromal symptoms.

Methods: Using descriptive/correlational design, 85 Middle Eastern women with a history of MI within the last 3-12 months, were enrolled in the study from cardiology clinics located in the Detroit metropolitan area, Michigan, United States. Data were collected by using the McSweeney Acute and Prodromal Myocardial Infarction Survey (MAPMISS), Response to Symptom Questionnaire (RSQ), and an MI-related prodromal symptoms knowledge survey. A structured interview was conducted for data collection, and data collection was performed by either phone or face-to- face interview. Self-identified Middle Eastern women who were living in the U.S. for at least one year and could understand and speak English, were included in this study. Women were excluded if they had a cognitive deficit, chest pain or any hemodynamic instability.

Results: The mean age of the participants was 56.45±10.79 years, ranging from 30 to 88 years old. About 45.7% of patients thought of non-cardiac reasons when they first started having symptoms. Gastrointestinal- related problems (34.6%) was the most common problem patients thought was happening to them. The MI episodes lasted 24±9.68 minutes and about 81.9% of women had pain during MI. The average reported pain score was 8.34±1.62. Women experienced 9.91± 6.97 number of acute symptoms and the mean intensity of the acute symptoms was 30.21±19.73. Back/between or under shoulder blades pain (55.4%), general chest pain (53.6%), and left arm/shoulder pain (53.1%), were the most reported acute symptoms. Older women experienced more acute (p=0.007) and prodromal symptoms than younger women (p=0.013). Women’s experiences of acute symptoms had a positive relationship with their history of HTN (p=0.024), chest pain/angina (p = 0.024), and a negative relationship with their age of menopause (p = 0.006). Approximately 90.6% of women reported experiencing at least one prodromal symptom. In total, women experienced 7.56±6.154 prodromal symptoms with mean intensity of 64.51±43.7. Pain in general chest (52.9%), pain centered high in chest, anxiety (both 48.2%), and unusual fatigue (47.1%), were the most reported prodromal symptoms. Women’s experience of prodromal symptoms had a significant relationship with their history of high cholesterol (p = 0.041), depression (p = 0.024), and having irregular periods in the year before MI (p = 0.000). Overall patients lacked knowledge on prodromal symptoms. Based on the survey that was scored, the total score was 33 and the mean score of the women’s knowledge was 12.15±7.99. Almost one third of the patients (35.4%) had delay in seeking medical help. The mean time of delay was 319±93 minutes (more than 5 hours). Less than half of the women (45.9%) used an ambulance for transportation to the hospital. Delay had a positive relation with being at home (p = 0.004), taking medication (p = 0.013), and waiting to see if symptoms go away (p = 0.002). There was a positive relation between experiencing prodromal symptoms and delay in seeking help (p= 0.012). In other words, the more patients experienced prodromal symptoms, the longer they delayed seeking help. The first MI (p = 0.014), experiencing acute symptoms of pain in back/between/under shoulder (0.032), and experiencing prodromal symptoms of pain through chest (p=0.05), predicted longer delay. Calling EMS (P= 0.043), and being accompanied with a colleague at the time of MI (p= 0.050), predicted shorter delay.

Conclusion: The results showed that Middle Eastern women experienced a wide range of acute and prodromal symptoms of MI, and these results were not exactly similar with those reported in the literature. This study also suggests the need for shortening delay time by addressing various influential factors i.e., cognitive, behavioral psychological. Culturally-sensitive education to improve Middle Eastern patients’ knowledge of symptoms and their ability to appropriately respond to the symptoms of MI are needed.

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