Men’s and women’s AMI symptoms differ

Look for nausea, jaw pain in women

Women with acute myocardial infarction (AMI) are more likely to present with nausea and back, jaw, or neck pain, whereas men are more likely to present with diaphoresis, reports a recent study^.1 Investigators studied patients hospitalized with AMI in 16 acute general hospitals in Worcester, MA. (See chart, below.)

Diaphoresis in men, nausea in women
	Men	Women
Chest pain	85%	75%
Diaphoresis	50%	40%
Shortness of breath	35%	45%
Nausea	30%	40%
Left arm pain	30%	32%
Right arm pain	15%	18%
Back pain	8%	15%
Neck pain	5%	12%
Left shoulder pain	10%	12%
Jaw pain	5%	8%
Right shoulder pain	5%	6%
Syncope	8%	10%
Epigastric discomfort	5%	4%
Source: Goldberg RJ, O’Donnell C, Yarzebski J, et al. Sex differences in symptom presentation associated with acute myocardial infarction: A population-based perspective. Am Heart J 1998; 136(2):189-195. ________

A minimum of two of these three criteria had to be satisfied for study inclusion:

• a clinical history of prolonged chest pain not relieved by rest or use of nitrates

• elevation of serum levels of creatine kinase and its isoenzyme subfraction or of lactic dehydrogenase

• serial EKG tracings obtained during hospitalization showing ST segment changes or Q waves (or both) consistent with AMI.

The value of this study is that patients need to understand that heart attacks manifest with many different symptoms — not all heart attacks are associated with acute chest pain or discomfort as traditionally believed. Women should be advised they may be more likely to experience nausea or back, jaw, or neck pain than men; whereas men should be aware that they may be more likely to experience diaphoresis.

Gender differences with symptoms may be due to differences in the way men and women experience and interpret their cardiac symptoms, and how they convey this information to health care providers. Several studies have shown that women and the elderly tend to delay longer in seeking medical care after the onset of acute coronary symptoms than men and younger individuals. A variety of reasons have been suggested — denial, erroneous symptom attribution, and failure to recognize signs and symptoms. The non-chest pain symptoms frequently occurring in women may be mistaken as musculoskeletal or neurologic in origin and inconsistent with onset of AMI, delaying a trip to the hospital.

Prior studies suggest women with confirmed AMI tend to have atypical presentations, including abdominal pain and dyspnea. Another found that women were more likely to present with nausea or vomiting and shortness of breath in addition to clinical findings consistent with heart failure. Although chest pain was similarly reported in the majority of men and women, it was reported as the chief complaint in a significantly greater proportion of men than women.

Reference

1. Goldberg RJ, O’Donnell C, Yarzebski J, et al. Sex differences in symptom presentation associated with acute myocardial infarction: A population-based perspective. Am Heart J 1998; 136(2):189-195.