Myocardial Infarction Signs and Symptoms: Females vs. Males

Abstract

Cardiovascular disease is the number one killer of females in the United States today, and myocardial infarction (MI) plays a role in many of these deaths. Females also present with more "atypical" symptoms than males and appear to have differences in pathophysiology underlying their MIs. Despite both differences in symptomology and pathophysiology being present in females versus males, a possible link between the two has not been studied extensively. In this systematic review, we analyzed studies examining differences in symptoms and pathophysiology of MI in females and males and evaluated possible links between the two. A search was performed for sex differences in MI in the databases PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature) Complete, Biomedical Reference Collection: Comprehensive, Jisc Library Hub Discover, and Web of Science. Seventy-four articles were ultimately included in this systematic review. Typical symptoms for both ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) such as chest, arm, or jaw pain were more common in both sexes, but females presented on average with more atypical symptoms such as nausea, vomiting, and shortness of breath. Females with MI also presented with more prodromal symptoms such as fatigue in days leading up to MI, had longer delays in presentation to the hospital after symptom onset, and were older with more comorbidities than males. Males on the other hand were more likely to have a silent or unrecognized MI, which concurs with their overall higher rate of MI. As they age, females have a decrease in antioxidative metabolites and worsened cardiac autonomic function than male. In addition, at all ages, females have less atherosclerotic burden than mles, have higher rates of MI not related to plaque rupture or erosion, and have increased microvasculature resistance when they have an MI. It has been proposed that this physiological difference is etiologic for the male-female difference in symptoms, but this has not been studied directly and is a promising area of future research. It is also possible that differences in pain tolerance between males and females may play a role in differing symptom recognition, but this has only been studied one time where females with higher pain thresholds were more likely to have unrecognized MI. Again, this is a promising area for future study for the early detection of MI. Finally, differences in symptoms for patients with different atherosclerotic burden and for patients with MI due to a cause other than plaque rupture or erosion has not been studied and are both promising avenues to improve detection and patient care in the future.

Characteristics and clinical outcomes of patients with Sarcoidosis admitted for ST-elevation myocardial infarction in the United States: A propensity matched analysis from the National Inpatient Sample

“…This study demonstrated significant disparities in patient characteristics between the 2 groups. Overall, there were more male patients with STEMI in both of our cohorts, which can be attributed to the well-documented difference in the prevalence of myocardial infarction between sexes [ 18 ]. However, when looking at each subgroup, there was a higher proportion of females seen in the sarcoidosis group compared to the non-sarcoidosis group.…”

Sex differences in cardiometabolic risk factors and in response to lifestyle intervention in prepubertal and pubertal subjects with obesity

“…The early detection and treatment of hypercholesterolemia is crucial to prevent atherosclerosis development ( 34 ), especially in males. Indeed, they have a higher incidence of myocardial infarction than females, with males accounting for approximately 70% of infarctions and having a myocardial infarction 7–10 years earlier than females ( 35 ).…”

Disparities and Outcomes in the First and Second Year of the Pandemic on Events of Acute Myocardial Infarction in Coronavirus Disease 2019 Patients

“…This may be due to gender disparity in cardiovascular care, where females remain underdiagnosed and undertreated in comparison to their male counterparts [48,49]. Another possible explanation of male predominance can lie in the pathophysiological differences between males and females, with females typically exhibiting a lesser extent of arterial plaque buildup, known as atherosclerotic burden, compared to men during a myocardial infarction (MI) [50]. Elevated microvascular resistance has been associated with unrecognized myocardial infarction (MI) in women, and after menopause, women are more likely to experience higher rates of resistance in their coronary microvasculature.…”

“…Elevated microvascular resistance has been associated with unrecognized myocardial infarction (MI) in women, and after menopause, women are more likely to experience higher rates of resistance in their coronary microvasculature. These alterations in the microvasculature due to aging and menopause might contribute to women experiencing more unusual symptoms that often remain undetected [50]. These variations between males and females warrant further research to better understand their potential implications for clinical practice, ultimately aiming to optimize cardiovascular care for individuals of all genders.…”