Background: The typical sign or main symptom in acute coronary syndrome (ACS) patients is chest pain, which is an initial benchmark or early sign for diagnosis. Certain factors, such as gender differences, the presence of diabetes mellitus or other clinical conditions, may make the patient not realize they have ACS. Therefore, this study aims to identify the characteristics of chest pain symptoms in male and female patients with ACS.
Design and Methods: This is a non-experimental quantitative study, namely analytical observation using a cross-sectional approach within 4 months (January-April 2019). Furthermore, the samples were 53 ACS patients (28 male and 25 female).
Results: The chest pain characteristics that have a significant relationship with gender differences in ACS patients are shown based on the aspects of location, pain duration and quality. Male patients are more likely to feel pain at the left or middle chest, the duration is between <20 to >20 min with moderate pain quality, which tends to become severe, while females are more likely to feel pain at the chest which radiates to the neck and chin, the duration is usually >20 min, with mild to moderate pain quality.
Conclusions: The result showed a significant difference in chest pain characteristics in male and female patients with ACS. Regarding location, duration and quality of chest pain, male ACS patients mostly have more typical symptoms, while females’ symptoms are atypical.
WHO. About Cardiovascular diseases. Geneva: WHO; 2015.
Dharma S, Andriantoro H, Dakota I, et al. Organisation of reperfusion therapy for STEMI in a developing country. BMJ Open Hert 2015;2:1-7. DOI: https://doi.org/10.1136/openhrt-2015-000240
Price SA, Wilson LM. [Patofisiologi Konsep Klinis Proses-Proses Penyakit (Pathophysiology of clinical concepts of disease processes)].[Book in Indonesian]. Jakarta: EGC; 2005.
Herlitz J, Wireklintsundstrom B, Bang A, et al. Early identification and delay to treatment in myocardial infarction and stroke: Differences and similarities. Scand J Trauma Resusc Emerg Med 2010;18:48. DOI: https://doi.org/10.1186/1757-7241-18-48
Rosamond W, Flegal K, Furie K, et al. Heart disease and stroke statistics–2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2008;117:e25-146. DOI: https://doi.org/10.1161/CIRCULATIONAHA.107.187998
DeVon HA, Ryan CJ, Rankin SH, et al. Classifying subgroups of patients with symptoms of acute coronary syndromes: A cluster analysis. Res Nurs Health 2010;33:386-97. DOI: https://doi.org/10.1002/nur.20395
Rosenfeld AG, Knight EP, Steffen A, et al. Symptom clusters in patients presenting to the emergency department with possible acute coronary syndrome differ by sex, age, and discharge diagnosis. Heart Lung 2015;44:368–75. DOI: https://doi.org/10.1016/j.hrtlng.2015.05.008
Thuresson M, Jarlov MB, Lindahl B, et al. Symptoms and type of symptom onset in acute coronary syndrome in relation to ST elevation, sex, age, and a history of diabetes. Am Heart J 2005;150:234-42. DOI: https://doi.org/10.1016/j.ahj.2004.08.035
Allana S, Khowaja K, Ali TS, et al. Gender differences in factors associated with prehospital delay among acute coronary syndrome patients in Pakistan. J Transcult Nurs 2014;26:480-90. DOI: https://doi.org/10.1177/1043659614524787
Benjamin EJ, Blaha MJ, Chiuve SE, et al. Heart disease and stroke statistics 2017 update: a Report from the American Heart Association. Circulation 2017;135:e146-603. DOI: https://doi.org/10.1161/CIR.0000000000000491
DeVon HA, Ryan CJ, Ochs AL, et al. Symptoms across the continuum of acute coronary syndromes: Differences between women and men. Am J Crit Care 2008;17:14-25. DOI: https://doi.org/10.4037/ajcc2008.17.1.14
Shin JY, Martin R, Suls J. Meta-analytic evaluation of gender differences and symptom measurement strategies in acute coronary syndromes. Heart Lung 2010;39:283-95. DOI: https://doi.org/10.1016/j.hrtlng.2009.10.010
Mehta LS, Beckie TM, DeVon HA, et al. Acute myocardial infarction in women: a scientific statement from the American Heart Association. Circulation 2016;133:916-47. DOI: https://doi.org/10.1161/CIR.0000000000000351
Martin R, Johnsen EL, Bunde J, et al. Gender differences in patients' attributions for myocardial infarction: implications for adaptive health behaviors. Int J Behav Med 2005;12:39-45. DOI: https://doi.org/10.1207/s15327558ijbm1201_6
Khan NA, Daskalopoulou SS, Karp I, et al. Sex differences in acute coronary syndrome symptom presentation in young patients. JAMA Int Med 2013;173:1863–71. DOI: https://doi.org/10.1001/jamainternmed.2013.10149
Van der Meer MG, Backus BE, van der Graaf Y, et al. The diagnostic value of clinical symptoms in women and men presenting with chest pain at the emergency department, a prospective cohort study. PLoS One 2015;10:e0116431. DOI: https://doi.org/10.1371/journal.pone.0116431
Mirzaei S, Steffen A, Vuckovic K, et al. The quality of symptoms in women and men presenting to the emergency department with suspected acute coronary syndrome. J Emerg Nurs 2019;45:357-65. DOI: https://doi.org/10.1016/j.jen.2019.01.001
Mackay MH, Ratner PA, Johnson JL, et al. Gender differences in symptoms of myocardial ischaemia. Eur Heart J 2011;32:3107-14. DOI: https://doi.org/10.1093/eurheartj/ehr358
Arora G, Bittner V. Chest pain characteristics and gender in the early diagnosis of acute myocardial infarction. Curr Cardiol Rep 2015;17:5. DOI: https://doi.org/10.1007/s11886-014-0557-5
Safdar B, Nagurney JT, Anise A, et al. Gender-specific research for emergency diagnosis and management of ischemic heart disease: proceedings from the 2014 Academic Emergency Medicine Consensus Conference Cardiovascular Research Workgroup. Acad Emerg Med 2014;21:1350-60. DOI: https://doi.org/10.1111/acem.12527
Canto JG. Symptom presentation of women with acute coronary syndromes. Arch Intern Med 2007;167:2405. DOI: https://doi.org/10.1001/archinte.167.22.2405
Rubini Gimenez M, Reiter M, Twerenbold R, et al. Sex-specific chest pain characteristics in the early diagnosis of acute myocardial infarction. JAMA Intern Med 2014;174:241-9. DOI: https://doi.org/10.1001/jamainternmed.2013.12199
Shabbir M, Kayani AM, Qureshi O, et al. Predictors of fatal outcome in acute myocardial infarction. J Ayub Med Coll Abbottabad 2008;20:14-6.
Patel H, Rosengren A, Ekman I. Symptoms in acute coronary syndromes: Does sex make a difference? Am Heart J 2004;148:27-33. DOI: https://doi.org/10.1016/j.ahj.2004.03.005
Arslanian-Engoren C, Patel A, Fang J, et al. Symptoms of men and women presenting with acute coronary syndromes. Am J Cardiol 2006;98:1177-81. DOI: https://doi.org/10.1016/j.amjcard.2006.05.049
Manfrini O, Ricci B, Cenko E, et al. Association between comorbidities and absence of chest pain in acute coronary syndrome with in-hospital outcome. Int J Cardiol 2016;217:S37-43. DOI: https://doi.org/10.1016/j.ijcard.2016.06.221
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