ObGFirst FREE TRIAL | Guideline Notifications | Daily Research Summaries | CME/CNE X

#Grand Rounds
CMECNECPE

The VIRGO Study Results: In Younger Individuals, Does Heart Attack Presentation Differ Between Women and Men?

FavoriteLoading

Learning Objectives and CME/Disclosure Information

This activity is intended for healthcare providers delivering care to women and their families.

After completing this activity, the participant should be better able to:

1. Recognize the common presenting symptoms in women, ages 18-55, who are having an acute myocardial infarction
2. Discuss the results of the VIRGO trial on differences between men and women who are undergoing an acute myocardial infarction

Estimated time to complete activity: 0.25 hours

Faculty:

Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project

Disclosure of Conflicts of Interest

Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

Faculty: Susan J. Gross, MD, receives consulting fees from Genoox, Inc., and has financial interest in The ObG Project, Inc.

Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.

Method of Participation and Request for Credit

Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from March 19 2018 through March 18 2019, participants must read the learning objectives and faculty disclosures and study the educational activity.

If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.

For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.

Joint Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Medical Education

Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Continuing Pharmacy Education

Postgraduate Institute for Medicine designates this continuing education activity for 0.25 contact hour(s) (0.25 CEUs) of the Accreditation Council for Pharmacy Education. (Universal Activity Number – JA4008162-9999-18-049-H01-P)

Type of Activity: Knowledge

Continuing Nursing Education

The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.

Read Disclaimer & Fine Print

BACKGROUND AND PURPOSE: 

  • Sex differences in the presentation of acute myocardial infarction (AMI) have been noted in older individuals  
  • Lichtman et al. (Circulation, 2018) examined whether the same holds true for symptoms in younger individuals undergoing an AMI 

METHODS: 

  • Prospective patient interviews during index AMI hospitalization that included the following information
    • Perception of symptoms 
    • Care seeking behaviors 
    • Symptoms: Chest pain | Pressure | Tightness, or discomfort | Dizziness | Indigestion or stomach pain | Pressure, burning, or discomfort | Nausea | Pain or discomfort in jaw, neck, arms, or between shoulder blades | Palpitations | Shortness of breath | Sweating | Weakness or fatigue | Confusion 
  • Participants were had been enrolled in the Variation in the Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) study (2008-2012)
    • 103 geographically diverse academic and nonacademic US hospitals  
    • 2:1 female:male enrollment design  
  • Patient characteristics and presentation information were compared by sex 
  • Multivariable hierarchical logistic regression was used to evaluate the correlation between sex and symptom presentation 

RESULTS: 

  • Data was collected from 2009 women and 976 men aged 18 to 55 years  
  • Majority of both males (89.5%) and females (87.0%) presented with chest pain 
  • Women were more likely to present with ≥3 associated symptoms than men (eg, epigastric symptoms, palpitations, and pain or discomfort in the jaw, neck, arms, or between the shoulder blades)
    • 61.9% for women versus 54.8% for men (P<0.001) 
  • In adjusted analyses, women with an ST-segment–elevation AMI (STEMI) were more likely than men to present without chest pain and report epigastric symptoms
    • Odds ratio, 1.51; 95% CI, 1.03–2.22
  • Consistent with studies of older patients, younger women were more likely to present with non–ST-segment–elevation AMI (NSTEMI) 
  • In comparison with men, women were more likely to perceive symptoms as stress/anxiety (20.9% versus 11.8%, P<0.001) but less likely to attribute symptoms to muscle pain (15.4% versus 21.2%, P=0.029) 
  • Women without chest pain were more likely to have diabetes mellitus, prior stroke or transient ischemic attack, chronic kidney disease, and chronic lung disease than women presenting with chest pain 
  • Approximately 29.5% of women and 22.1% of men sought medical care for similar symptoms before their hospitalization (P<0.001) 
  • However, 53% of women reported that their provider did not think these symptoms were heart-related in comparison with 37% of men (P<0.001) 

CONCLUSION: 

  • Chest pain (approximately 90%) remains the main symptom for both males and females with an acute myocardial infarction 
  • Women will present with a greater number of non-chest pain symptoms than men including  
    • Epigastric symptoms (indigestion, nausea, and stomach pain, pressure, burning, or discomfort)  
    • Pain or discomfort in the jaw, neck, arms, or between the shoulder blades 
    • Palpitations 
    • Shortness of breath 
  • The authors state that in the case of women,  

…the presentation of chest pain within the context of multiple symptoms may influence the prompt recognition of heart disease and initial actions on the part of providers. 

Learn More – Primary Sources: 

Sex Differences in the Presentation and Perception of Symptoms Among Young Patients With Myocardial Infarction

Take a post-test and get CME credits

FavoriteLoading

Related ObG Topics:

Is Acute Myocardial Infarction Associated with the Flu?
Does Oxygen Therapy Really Help During a Suspected Heart Attack?
Do Pay for Performance Incentives Enhance Hospital Performance?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month