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Women more likely than men to not have chest pain with ACS

Tuesday September 17, 2013
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A higher proportion of women than men ages 55 and younger did not present with chest pain during acute coronary syndromes, although chest pain was the most common symptom for both sexes, according to a study.

Chest pain is a classic symptom that often triggers diagnostic testing for ACS, but as many as 35% of patients with ACS do not report chest pain at presentation, according to background information in the study, which was published Sept. 16 on the website of JAMA Internal Medicine. They are more likely to be misdiagnosed in the ED and have a higher risk of death compared with patients who report chest pain.

Nadia A. Khan, MD, MSc, of the University of British Columbia in Vancouver, and colleagues evaluated sex differences in how younger patients with ACS presented for medical care. The study included 1,015 patients (70% men) who were 55 and younger, hospitalized for ACS and enrolled in a study of gender, sex and cardiovascular disease. The median age of the patients was 49.

According to the results, 19% of women and 13.7% of men presented without chest pain. Young women without chest pain also had fewer symptoms in general compared with women with chest pain (average number of symptoms, 3.5 vs. 5.8) with similar findings in men (2.2 vs. 4.7 symptoms).

The most common non-chest pain symptoms in both sexes were weakness, feeling hot, shortness of breath, cold sweat and pain in the left arm or shoulder. Women without chest pain had more symptoms than men without chest pain.

The authors noted patients without chest pain did not differ from those with chest pain in ACS type, troponin level elevation or coronary stenosis.

“The most significant findings in this study were that chest pain was the most predominant symptom of ACS in both men and women 55 years or younger, regardless of ACS type,” the authors wrote. “Women had a higher likelihood of presenting without chest pain than men. Most women and men who presented without chest pain, however, reported at least one other non-chest pain symptom, such as shortness of breath or weakness.”

The reasons for the sex difference in ACS symptom presentation were not clear, the authors wrote.

“Our findings indicate that chest pain is the predominant symptom that should direct diagnostic evaluation for ACS and should be used for public health messaging for young women and men similar to older patients,” the authors concluded. “However, healthcare providers should still maintain a high degree of suspicion for ACS in young patients, particularly women, given that one in five women with diagnosed ACS do not report with chest pain.”

Study abstract: http://archinte.jamanetwork.com/article.aspx?articleid=1738716.


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