Symptom Presentation of Women With Acute Coronary Syndromes

Abstract

Background: Optimal diagnosis and timely treatment of patients with an acute coronary syndrome (ACS) depends on distinguishing differences between popular "myths" about ischemic symptoms in women and men. Chest pain or discomfort is regarded as the hallmark symptom of ACS, and its absence is regarded as "atypical" presentation. This review describes the presenting symptoms of ACS in women compared with men and ascertains whether women should have a symptom message that is separate or different from that for men. Methods: MEDLINE (1970-2005), bibliographies of articles, and pertinent abstracts were reviewed, focusing on studies of ACS presentation, especially those reporting differences in symptoms by sex. This analysis included 69 of 361 possible studies. Data regarding symptom presentation were recorded. Results: The published literature lacks standardization in characterizing ACS presentation, data collection, and reporting of symptoms. Approximately one-third of patients in the large cohort studies and one-quarter of patients in the smaller reports and direct patient interviews presented without chest pain or discomfort. The absence of chest pain or discomfort with ACS was noted more commonly in women than in men in both the cumulative summary from large cohort studies (37% vs 27%) and the single-center and small reports or interviews (30% vs 17%). Conclusions: Women are significantly less likely to report chest pain or discomfort compared with men. These differences, however, are not likely large enough to warrant sex-specific public health messages regarding the symptoms of ACS at the present time. Further research must systematically investigate sex differences in the clinical presentation of ACS symptoms and must include standardized data collection efforts.

Help seeking for cardiac symptoms: Beyond the masculine–feminine binary

“…Those who have reported that there is a sex-based difference (anatomical or physiological in nature) have postulated that women do not recognize their cardiac symptoms because health educators' characterizations are based on men's experiences when women's symptoms are different from the "hallmark" symptoms -they are "atypical" and consequently not recognized as serious (O'Keefe-McCarthy, 2008). Canto et al (2007) however hypothesized that this apparent difference is more likely the result of differences in age at the time of a cardiac event, rather than being a sex difference (women are generally older than men when they first experience an acute coronary syndrome and age influences the symptom experience). Others have suggested that there are gender differences in helpseeking behavior and they are social in nature.…”

Diversity in Clinical and Biomedical Research: A promise yet to be fulfilled

“…clinically relevant scientific contributions by identifying sex-specific differences in symptoms, pathologies, and treatment response [2][3][4]. In continuation of this effort, the NIH announced new measures to enhance gender equity [5].…”

An incidental case of Wellens' syndrome in a community emergency department

“…[6][7] Moreover, her serial troponin T levels were slightly elevated and ECG changes were noted while she was pain free. ECG changes included inverted T waves in V2 and V3.…”