Chest Pain When the Heart's Blood Flow Slows

Chest pain in acute coronary syndrome found to be most common symptom in both men and women

(RxWiki News) Women and men have often reported different symptoms of heart disease. Knowing what specific symptoms may be related to a person's sex may help doctors diagnose a dangerous heart condition more quickly.

A recent study was conducted to see if there were any differences in how men and women with acute coronary syndrome (ACS; any condition brought on by sudden, reduced blood flow to the heart) presented, and to see if patients without chest pain had a differing severity of the condition than those with chest pain.

The researchers found that chest pain was the most common ACS symptom in all patients — both men and women. The findings also showed that chest pain was not a factor in coronary disease severity.

The researchers also concluded that common non-chest pain symptoms should also be considered when getting tested for in ACS.

"Talk to your doctor about reducing risks of heart disease."

The lead author of this study was Nadia A. Khan, MD, MSc, from the Department of Medicine in the Center for Health Evaluation and Outcomes Science at the University of British Columbia in Vancouver, Canada.

The researchers studied 1,015 patients — 305 female and 710 male — from the GENESIS PRAXY study. All patients were 55 years old or younger, and were hospitalized for ACS.

The patients self-reported their age, economic status, level of education, marital status, sex, gender, primary earner status and ethnicity. Body weight, height, blood pressure and heart rate were obtained from medical records.

Lastly, the patients were tested for levels of depression and anxiety.

The researchers found that chest pain was the most common symptom of ACS and was experienced by both men and women, regardless of severity or type of ACS. However, women experienced chest pain less than the men, with 19 percent of women having no chest pain, compared to 14 percent of men.

The researchers also found that being a woman and having tachycardia (above normal heart rate) were the two factors that were independently associated with ACS with no chest pain.

The patients without chest pain reported that the most common non-chest pain symptoms were weakness, shortness of breath, feeling hot, cold sweats and pain in the left arm or shoulder. Out of these symptoms, cold sweats and weakness were the only two symptoms that were found to be associated with markers of ACS severity.

Markers of ACS severity include type of ACS, troponin (protein released when the heart muscled has been damaged) level elevation and extent of coronary stenosis (artery is blocked by fat cells). The researchers also discovered that the total number of ACS symptoms was not associated with these severity markers.

The findings showed that men and women typically reported similar non-chest pain symptoms, although women were found to experience these more than men.

The researchers believe that the reliance on chest pain alone may lead to undiagnosed cases of ACS, especially in young women. The researchers also found that the absence of chest pain did not mean less severe ACS.

The authors noted a few limitations of their study.

First, the study only included patients who had already been diagnosed with ACS, so the researchers were not able to observe patients who were misdiagnosed with something other than ACS, who didn't get medical help or who died before coming to the hospital.

Second, the researchers were not able to interview patients who died shortly after coming to the hospital. Lastly, the study population was not large enough to definitively determine sex differences.

This study was published online ahead-of-print in September in JAMA Internal Medicine.

The Canadian Institutes of Health Research and the Heart and Stroke Foundations of Québec, Nova Scotia, Alberta, Ontario, Yukon and British Columbia provided funding.

Review Date: 
September 19, 2013