Symptoms of Acute Myocardial Infarction in Young Women and Men

Authors: Lichtman JH et al. 

Circulation 2018 Feb 20.

It has been reported that women and men suffering acute myocardial infarction (AMI) present with different symptomatology. To ascertain this in adults aged ≤55, researchers analyzed data from standardized patient interviews in the multisite VIRGO study of 2985 patients hospitalized with AMI; patients were enrolled in a 2:1 female-to-male ratio (mean age, 47; 76% white).

Chest pain, pressure, tightness, or discomfort was a presenting symptom in 87% of women and 90% of men. Overall, women presented with a greater number of additional non–chest-pain symptoms than men; 62% of women and 55% of men presented with ≥3 such symptoms. In adjusted analyses, women aged >45 had a 40% greater likelihood of presenting without chest pain than men. Women with ST-segment elevation MIs were 50% more likely than men to present without chest pain. More than half of patients initially thought that their symptoms were due to a non–heart-related condition, with indigestion and acid reflux the most common self-diagnoses. Women were more likely than men to attribute their symptoms to stress and anxiety (21% vs. 12%); men were more likely to attribute them to muscle pain (21% vs. 15%). Women waited longer to seek medical attention (3.2 hours vs. 2.4 hours). Prehospitalization, more women than men had sought medical attention for similar symptoms (30% vs. 22%); over half of the women reported that the clinicians did not deem their symptoms to be heart-related (53% vs. 37% of men).