It’s somewhat dogmatic in medicine to teach men and women present with differing symptoms during myocardial infarction. Women are, as they say, more likely to have “atypical” symptoms.
This study differs slightly from previous accounting of the presenting symptoms of men and women with potential cardiac ischemia. This is a pre-planned, prospective analysis accompanying the High-STEACS trial, featuring in part an evaluation of gender-specific cut-offs for high-sensitivity troponin. As part of this trial, rather than using a typical “conventional” troponin cut-off for the 99th percentile of 50 ng/L, they used 16 ng/L for women and 34 ng/L for men. These cut-offs were correlated with clinical information to determine the diagnosis of type I myocardial infarction, generating a prevalence of 16% for men and 12% for women among the 1,941 included in the analysis.
Among these, authors found similar prevalence of “typical” symptoms – dull, tight, pressure, aching, crushing, in the chest, arm or jaw – in women as men considered for potential acute coronary syndrome. Among those ultimately diagnosed with type I MI, women were actually slightly more likely to manifest “typical” symptoms – 77% versus 59%. The authors did not find the presence of multiple “typical” symptoms to have a terribly useful positive likelihood ratio for MI in either women or men.
Unfortunately, these data run into unavoidable selection bias: “All patients over 18 years of age in whom the attending clinician requested cardiac troponin for suspected acute coronary syndrome were eligible for inclusion.” Therefore, the so-called “atypical” presentation in which ACS was not suspected – i.e., the women with “atypical” presentations – would be, by definition, missed. It may be the difference between men and women is not as great as originally thought – but these data cannot definitively answer the question.
“Presenting Symptoms in Men and Women Diagnosed With Myocardial Infarction Using Sex-Specific Criteria”
https://www.ahajournals.org/doi/10.1161/JAHA.119.012307