Sex differences in prodromal symptoms in acute coronary syndrome in patients aged 55 years or younger

Abstract

Prior to ACS, women were more likely to experience prodromal symptoms and seek medical attention than men. Prehospital care was generally similar between sexes but demonstrated underutilisation of risk-reduction therapies in at-risk young adults.

Young Women With Acute Myocardial Infarction

“…In young women, the most common prodromal symptom leading up to the AMI is fatigue. 42 Additionally, in the month prior to presentation of AMI, young women have a poorer health status and worse psychosocial status than men. Specifically, women report worse physical/mental functioning, more angina, worse physical limitations, and a poorer quality of life prior to their AMI.…”

Acute Myocardial Infarction in Women

“…However, women were more likely to present with more symptoms but less chest pain compared with men. 185 Similarly, compared with men, women ≤45 years of age with AMI are significantly more likely to present without chest pain and to have higher in-hospital mortality. 41 A qualitative study of women 30 to 55 years of age with AMI found that although they reported a diverse range of symptoms from discomfort or pain (eg, chest, neck and jaw) to more general symptoms (eg, sweating, anxiety, fatigue, and dizziness), the majority reported chest pain.…”

“…[184][185][186] Although most patients with AMI present with typical chest pain or chest discomfort, women often present with atypical chest pain and anginaequivalent symptoms such as dyspnea, weakness, fatigue, and indigestion, as illustrated in Table 1. 187 Sex differences in clinical presentation have consequences for timely identification of ischemic symptoms, appropriate triage, and judicious diagnostic testing and management.…”

“…41,185,188 Pain in the upper back, arm, neck, and jaw, as well as unusual fatigue, dyspnea, indigestion, nausea/ vomiting, palpitations, weakness, and a sense of dread, occur more frequently in women compared with men. [189][190][191][192][193] Ischemic symptoms in young black women include unusual fatigue, shortness of breath, chest discomfort, or frequent indigestion, with older white women displaying fewer symptoms.…”

Delays in Seeking Care

“…4,5 Of course, women may also be somewhat more likely to experience atypical symptoms, such as nausea, shortness of breath, and back pain in the setting of ischemia, though data are mixed in terms of the degree to which this differs from men's symptom experience, [6][7][8][9] and women with myocardial infarction (MI) are more likely than men to present without chest pain. 10,11 This is particularly important because the absence of chest pain as a presenting symptom has been associated with increased mortality, especially among younger women with MI. 10 Overall, though, the similarities far outweigh the differences, and although women may be slightly more likely to fit into this atypical category, both sexes need to know that atypical symptoms are common.…”