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Introduction

 

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Because a woman’s symptoms of angina may be substantially different from a man’s, she is less likely to recognize them as cardiac in nature and seek medical attention.

The most common symptom of CHD is chest pain. However, there is much difference in how this disease presents itself in men and women.

Evaluation of chest pain symptoms in women is often misdiagnosed as clinicians have tried to apply the "typical" angina definition derived from male patients to female patients.  However, differences exist in the frequency and quality of symptoms in men and women.  Women are much less likely to have typical angina symptoms.  In a study of 3,100 patients undergoing exercise stress testing, 28% of women vs. 55% of patients had typical anginal pain .

Women are also more likely to have symptoms such as unexplainable fatigue, sleep disturbance, nausea, shortness of breath and back pain compared to men.  In patients who do present with acute coronary symptoms, myocardial infarction has been found to have occurred twice as likely in men as in women. In acute coronary syndromes (ACS), the initial presentation of chest pain is more common in men than women.  However, women with acute MI are known to be older and more susceptible to complications, hence making diagnosis a key. The presence of hypertension or diabetes increases the probability of diagnosis of acute MI[1].

To evaluate and categorize angina, physicians employ the Rose questionnaire. This questionnaire assesses the probability of angina by evaluating responses to questions such as:

  • whether the pain comes with exertion

  • requires the person to stop or slow down

  • goes away within 10 minutes

  • is located over the sternum or in both the left chest and left arm

The Rose questionnaire has been validated in men by comparing results with clinical diagnosis and ECG findings. However, the specificity of the Rose questionnaire drops from 77% in men to 56% in women.

It is important to recognize that men and women experience and respond to acute myocardial infarctions within the context of societal influences. The lay public believes the following are the most common symptoms of a heart attack: chest pain, irregular heart beat, shortness of breath, and an inability to move. However, clinicians use the classical symptoms of diaphoresis, nausea and vomiting, weakness, and syncope in assessing patients.

Interestingly, psychosocial factors are much more important in women than in men.  Women tend to drastically underestimate their risk of heart disease .  Studies have reported that women experiencing symptoms of MI often attended to their social responsibilities as a mother or homemaker, whereas men focus on the need for care of their symptoms.  Women also appeared to solicit more input and advice from the closest people to them, whereas men are more directive once they realized the urgency of their symptoms.

The following table is a summary of the signs and symptoms and co-morbidities that are most common in each sex, although not exclusively.

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1. Zucker, D.R., Griffith, J.L., Beshansky, J.R., Selker, H.P., (1997) Presentations of Acute Myocardial Infarction in Men and Women. J Gen Intern Med, 12:78-87.

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