Skip to main content

Advertisement

Log in

Chest Pain Characteristics and Gender in the Early Diagnosis of Acute Myocardial Infarction

  • Ischemic Heart Disease (D Mukherjee, Section Editor)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Acute myocardial infarction is one of the leading causes of cardiovascular disease mortality in both men and women. Chest pain, which is often described as chest pressure, tightness, or a squeezing sensation, is the most frequent symptom in patients presenting with acute myocardial infarction. Although the diagnosis of acute myocardial infarction is often based on typical changes on a surface electrocardiogram and on changes in cardiac biomarkers, there is a need to better recognize and understand the impact of sex on symptoms among patients presenting with acute coronary syndrome or acute myocardial infarction. We briefly review the pathophysiology of ischemic symptoms, discuss potential mechanisms for variation in ischemic symptoms by sex, and summarize recent publications that have addressed sex differences in ischemic symptoms.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke statistics-2014 update: a report from the American Heart Association. Circulation. 2014;129(3):e28–292.

    Article  PubMed  Google Scholar 

  2. Canto JG, Rogers WJ, Goldberg RJ, et al. Association of age and sex with myocardial infarction symptom presentation and in-hospital mortality. JAMA. 2012;307(8):813–22.

    Article  CAS  PubMed  Google Scholar 

  3. Gupta A, Wang Y, Spertus JA, et al. Trends in acute myocardial infarction in young patients and differences by sex and race, 2001 to 2010. J Am Coll Cardiol. 2014;64(4):337–45.

    Article  PubMed  Google Scholar 

  4. Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition of myocardial infarction. J Am Coll Cardiol. 2012;60(16):1581–98.

    Article  PubMed  Google Scholar 

  5. Nawar EW, Niska RW, Xu J. National hospital ambulatory medical care survey, emergency department summary. Adv Data. 2005;2007(386):1–32.

    Google Scholar 

  6. Yeh RW, Sidney S, Chandra M, et al. Population trends in the incidence and outcomes of acute myocardial infarction. N Engl J Med. 2010;362(23):2155–65.

    Article  CAS  PubMed  Google Scholar 

  7. Meischke H, Larsen MP, Eisenberg MS. Gender differences in reported symptoms for acute myocardial infarction: impact on prehospital delay time interval. Am J Emerg Med. 1998;16(4):363–6.

    Article  CAS  PubMed  Google Scholar 

  8. Chen W, Woods SL, Puntillo KA. Gender differences in symptoms associated with acute myocardial infarction: a review of the research. Heart Lung J Crit Care. 2005;34(4):240–7.

    Article  Google Scholar 

  9. Shin JY, Martin R, Suls J. Meta-analytic evaluation of gender differences and symptom measurement strategies in acute coronary syndromes. Heart Lung J Crit Care. 2010;39(4):283–95.

    Article  Google Scholar 

  10. Gibbons RJ, Balady GJ, Bricker JT, et al. ACC/AHA 2002 guideline update for exercise testing: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). Circulation. 2002;106(14):1883–92.

    Article  PubMed  Google Scholar 

  11. Arslanian-Engoren C, Engoren M. Physiological and anatomical bases for sex differences in pain and nausea as presenting symptoms of acute coronary syndromes. Heart Lung J Crit Care. 2010;39(5):386–93.

    Article  Google Scholar 

  12. Kreatsoulas C, Shannon HS, Giacomini M, et al. Reconstructing angina: cardiac symptoms are the same in women and men. JAMA Intern Med. 2013;173(9):829–31. This study shows that there are no differences in anginal symptoms between men and women with stable CAD.

    Article  PubMed  Google Scholar 

  13. Mackay MH, Ratner PA, Johnson JL, et al. Gender differences in symptoms of myocardial ischaemia. Eur Heart J. 2011;32(24):3107–14.

    Article  PubMed  Google Scholar 

  14. Tamura A, Naono S, Torigoe K, et al. Gender differences in symptoms during 60-second balloon occlusion of the coronary artery. Am J Cardiol. 2013;111(12):1751–4.

    Article  PubMed  Google Scholar 

  15. Devon HA, Rosenfeld A, Steffen AD, et al. Sensitivity, specificity, and sex differences in symptoms reported on the 13-item acute coronary syndrome checklist. J Am Heart Assoc. 2014;3(2):e000586. This is a prospective multi-center study that sought to determine the influence of gender on symptoms during ACS.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Rubini Gimenez M, Reiter M, Twerenbold R, et al. Sex-specific chest pain characteristics in the early diagnosis of acute myocardial infarction. JAMA Intern Med. 2014;174(2):241–9. This prospective study shows that differences in chest pain characteristics by gender are small and are not powerful enough to be used clinically in the diagnosis of AMI.

    Article  PubMed  Google Scholar 

  17. Khan NA, Daskalopoulou SS, Karp I, et al. Sex differences in acute coronary syndrome symptom presentation in young patients. JAMA Intern Med. 2013;173(20):1863–71.

    PubMed  Google Scholar 

  18. Eastwood JA, Johnson BD, Rutledge T, et al. Anginal symptoms, coronary artery disease, and adverse outcomes in Black and White women: the NHLBI-sponsored Women’s Ischemia Syndrome Evaluation (WISE) study. J Women’s Health. 2013;22(9):724–32.

    Article  Google Scholar 

  19. Reis SE, Holubkov R, Conrad Smith AJ, et al. Coronary microvascular dysfunction is highly prevalent in women with chest pain in the absence of coronary artery disease: results from the NHLBI WISE study. Am Heart J. 2001;141(5):735–41.

    Article  CAS  PubMed  Google Scholar 

  20. Marroquin OC, Holubkov R, Edmundowicz D, et al. Heterogeneity of microvascular dysfunction in women with chest pain not attributable to coronary artery disease: implications for clinical practice. Am Heart J. 2003;145(4):628–35.

    Article  PubMed  Google Scholar 

  21. Murthy VL, Naya M, Taqueti VR, et al. Effects of sex on coronary microvascular dysfunction and cardiac outcomes. Circulation. 2014;129(24):2518–27.

    Article  PubMed  Google Scholar 

  22. Burg MM, Edmondson D, Shimbo D, et al. The ‘perfect storm’ and acute coronary syndrome onset: do psychosocial factors play a role? Prog Cardiovasc Dis. 2013;55(6):601–10.

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Garima Arora and Vera Bittner declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Vera Bittner.

Additional information

This article is part of the Topical Collection on Ischemic Heart Disease

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Arora, G., Bittner, V. Chest Pain Characteristics and Gender in the Early Diagnosis of Acute Myocardial Infarction. Curr Cardiol Rep 17, 5 (2015). https://doi.org/10.1007/s11886-014-0557-5

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11886-014-0557-5

Keywords

Navigation