Gender differences in symptom presentation associated with coronary heart disease

Milner, Kerry A.; Funk, Marjorie; Richards, Sally; R, Wilmes; Vaccarino, Viola; Krumholz, Harlan M.

doi:10.1016/s0002-9149(99)00322-7

Cited by 228 publications

(131 citation statements)

References 6 publications

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“…Similar sensory sensations for chronic angina and other co-morbid conditions may make it difficult for patients to ascertain the source of their symptoms leading to inappropriate decision-making about when to seek medical attention and what physical activity may be safely conducted. Second, research suggests that during acute myocardial infarction, women are more likely than men to experience GI symptoms such as indigestion (Milner et al, 1999) and nausea (Goldberg et al, 2000). Women with chronic angina who have sensory sensations similar to GI discomfort as part of their stable symptom pattern may be less likely to seek treatment for acute myocardial infarction escalation of their symptoms involving GI discomfort, as they may not be able to distinguish acute symptoms from chronic stable symptoms.…”

Section: Discussionmentioning

confidence: 99%

Gender differences in pain characteristics of chronic stable angina and perceived physical limitation in patients with coronary artery disease

Kimble

McGuire

Dunbar

et al. 2003

Pain

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Chronic stable angina pectoris, the chest pain associated with reversible myocardial ischemia has detrimental effects on health-related quality of life, particularly in women. The limited research on gender differences in chronic stable angina suggests that angina may be experienced differently in women and that women report greater functional disability related to angina symptoms. No studies have examined gender differences in chronic stable angina from a multidimensional pain perspective or have included reliable and valid measures of pain that would facilitate comparing chronic angina patients with other chronic pain populations. The purpose of this descriptive study was to examine gender differences in characteristics of chronic stable angina using the short-form McGill pain questionnaire (SF-MPQ) and to explore relationships among these pain characteristics and perceived limitation in performing physical activities in patients with coronary artery disease (CAD) (physical limitation subscale of the Seattle angina questionnaire). One hundred and twentyeight subjects (30.5% women) with stable CAD and angina pectoris documented by a cardiologist completed study questionnaires in an outpatient cardiology clinic. Results of the study suggest that men and women with chronic stable angina had more similarities than differences in chest pain characteristics. No significant gender differences were demonstrated in total sensory or affective intensity scores, the present pain intensity index, or the number of pain words chosen. However, women did report significantly greater pain intensity on the SF-MPQ visual analogue scale. Women were also significantly more likely to describe their chronic angina as 'hot-burning' and 'tender' and to have greater intensity of pain for these two descriptors. Despite the similarities in pain characteristics, women reported greater physical limitation related to anginal pain. The variables of social status and years diagnosed with CAD significantly interacted with gender in predicting physical limitation suggesting that gender-specific models of physical limitation in angina patients need to be explored. To our knowledge, this is one of the first studies that has assessed chronic anginal pain using a reliable and valid generic pain instrument. More research is needed to better understand the nature of gender differences in functional limitation secondary to anginal pain and the physiologic, cognitive-perceptual and psychosocial mechanisms that lead to angina-related functional disability.

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Section: Discussionmentioning

confidence: 99%

Gender differences in pain characteristics of chronic stable angina and perceived physical limitation in patients with coronary artery disease

Kimble

McGuire

Dunbar

et al. 2003

Pain

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“…Patient complaints that are CHD symptoms but not exclusively indicative of CHD, such as gastrointestinal discomfort and mood changes, [26][27][28][29][30] were presented in the vignette because patients seldom appear as clear-cut cases. Our purpose was not to make the physicians' diagnostic task more difficult but to increase the clinical authenticity of the scenario, so that it more accurately represented how actual patients appear and allows results to be useful in practice.…”

Section: Maserejian Et Almentioning

confidence: 99%

Disparities in Physicians' Interpretations of Heart Disease Symptoms by Patient Gender: Results of a Video Vignette Factorial Experiment

Maserejian

Link

Lutfey

et al. 2009

Journal of Women's Health

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Background: Previous studies have documented the underdiagnosis of coronary heart disease (CHD) in women, but less is known about which alternate diagnoses take precedence and whether additional patient factors modify possible gender bias. Objective: To measure gender variation in clinical decision making, including (1) the number, types, and certainty levels of diagnoses considered and (2) how diagnoses vary according to patient characteristics, when patients have identical symptoms of CHD. Methods: This was a factorial experiment presenting videotaped CHD symptoms, systematically altering patient gender, age, socioeconomic status (SES) and race, and physician gender and level of experience. The primary end point was physicians' most certain diagnosis. Results: Physicians (n ¼ 128) mentioned five diagnoses on average, most commonly heart, gastrointestinal, and mental health conditions. Physicians were significantly less certain of the underlying cause of symptoms among female patients regardless of age ( p ¼ 0.006), but only among middle-aged women were they significantly less certain of the CHD diagnosis ( p < 0.001). Among middle-aged women, 31.3% received a mental health condition as the most certain diagnosis, compared with 15.6% of their male counterparts ( p ¼ 0.03). An interaction effect showed that females with high SES were most likely to receive a mental health diagnosis as the most certain ( p ¼ 0.006). Conclusions: Middle-aged female patients were diagnosed with the least confidence, whether for CHD or non-CHD conditions, indicating that their gender and age combination misled physicians, particularly toward mental health alternative diagnoses. Physicians should be aware of the potential for psychological symptoms to erroneously take a central role in the diagnosis of younger women.

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“…Our findings are similar to the results of other researchers where women also have atypical symptoms of CAD more often than men. Among these the most common are back pain and lower jaw pain, shortness of breath, nausea, fatigue, cough and palpitations [23][24][25][26] .…”

Section: Resultsmentioning

confidence: 99%

Gender differences in the clinical presentation, treatment and outcomes of acute myocardial infarction

et al. 2018

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Abstract. Aim: To assess the epidemiological and clinical differences between men and women with acute myocardial infarction (AMI). Patients and methods: This retrospective study included 579 patients (352 men and 221 women) who were hospitalized at the Coronary and postcoronary unit at the General Hospital, Karlovac, Croatia, from 2013 to 2016. We determined the frequency, patient's age, type of symptoms, cardiovascular risk the factors, localization, the time from the onset of symptoms to arrival to the hospital, treatment and complications during the hospitalization. Results: AMI is more frequent in men than in women (P < 0.001) and in men it is significantly more likely to occur at an earlier age than in women (P < 0.001). Men often have typical symptoms while women have atypical symptoms (P = 0.045). More often women have arterial hypertension (P = 0.017) and diabetes (P = 0.025), while men are more often smokers (P = 0.001). There was no difference between the gender regarding hyperlipidemia (P = 0,674). Distribution of localization (P = 0.608), the time required for the arrival to the hospital (P = 0.399) and all the complications of AMI are equal (P = 0.365). Men are more likely to receive PCI treatment, while women get the conservative therapy (P = 0.007). Conclusion: Compared with other studies, our women with AMI have less hyperlipidemia and do not come later to hospital than men. Possible causes are dietary habits and genetics or education and good organization of outpatient emergency medical assistance.Key words: acute myocardial infarction; cardiovascular risk; Croatia; hospital treatment Sažetak. Cilj: Ispitati epidemiološke i kliničke razlike između žena i muškaraca s akutnim infarktom miokarda (AIM). Bolesnici i metode: Ova retrospektivna studija obuhvatila je 579 pacijenata (352 muškarca i 221 ženu) hospitaliziranih u koronarnoj i postkoronarnoj jedinici Opće bolnice Karlovac, Hrvatska, od 2013. do 2016. godine. Utvrdili smo učestalost, dob pacijenata, tip simptoma, kardiovaskularne rizične čimbenike, lokalizaciju, vrijeme od početka simptoma do dolaska u bolnicu, liječenje i komplikacije tijekom hospitalizacije AIM-a. Rezultati: AIM je češći kod muškaraca nego kod žena (P < 0,001) i kod muškaraca je značajno vjerojatnije da će se pojaviti u ranijoj dobi nego kod žena (P < 0,001). Muškarci češće imaju tipične simptome, a žene atipične simptome (P = 0,045). Žene imaju češće arterijsku hipertenziju (P = 0,017) i dijabetes (P = 0,025), dok su muškarci češće pušači (P = 0,001). Hiperlipidemija je podjednako zastupljena u oba spola (P = 0,674). Distribucija lokalizacije (P = 0,608), vrijeme potrebno za dolazak u bolnicu (P = 0,399) i sve komplikacije AIM-a podjednako su česti (P = 0,365). Muškarci se češće liječe invazivnom, a žene konzervativnom terapijom. Zaključak: U usporedbi s drugim istraživanjima naše žene s AIM-om imaju manju učestalost hiperlipidemije i ne dolaze kasnije u bolnicu od muškaraca. Mogući razlozi su prehrambene navike i genetika ili obrazovanje i dobra organizacija izvanbolničk...

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Gender differences in symptom presentation associated with coronary heart disease

Cited by 228 publications

References 6 publications

Gender differences in pain characteristics of chronic stable angina and perceived physical limitation in patients with coronary artery disease

Gender differences in pain characteristics of chronic stable angina and perceived physical limitation in patients with coronary artery disease

Disparities in Physicians' Interpretations of Heart Disease Symptoms by Patient Gender: Results of a Video Vignette Factorial Experiment

Gender differences in the clinical presentation, treatment and outcomes of acute myocardial infarction

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