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

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