Symptom Presentation

Photo provided from http://www.lclark.edu/~krauss/hatchetweb/chapter1abdulaziz/Abdulazizheartattack.html

The failure of physicians to accurately diagnose cardiovascular disease in women can partially be attributed to the gender difference in symptom presentation and diagnostic sensitivity. To an extent the symptoms of angina and myocardial infarction are the same for both sexes: chest pain triggered by effort, with or without radiation to part of the thorax, arms or head. However, beyond the most apparent symptoms, cardiovascular disease often presents differently in women than in men, impacting early diagnosis.

In clinical practice, women tend to express their symptoms differently. Common expressions are ‘discomfort, unease in the chest, breathlessness, fatigue, weakness” etc. Due to the different description of angina symptoms, there is a larger risk that the symptoms may be misinterpreted, and their disease be overlooked. It has not been clarified whether this is due to their having a different experience of pain or that they communicate in another way.
In a recent study, women who were admitted to the coronary care units more often presented with unstable angina rather than acute myocardial infarction, suggesting a slower pace of the acute onset phase as compared to men.
The sensitivity and specificity of standard diagnostic techniques, such as graded exercise tolerance tests and stress imaging studies, are poorer for women than for men. The diagnostic value of coronary artery calcification in diabetic individuals, for example, is lower in women than in men.
Women without diabetes present with complaints of angina more frequently than do men, who present more often with myocardial infarction (MI). Women are also more likely to have jaw or neck and shoulder pain, nausea, vomiting, fatigue, or shortness of breath (dyspnea) in addition to the more traditional substernal chestpain during an acute MI.

Timely diagnosis is crucial for treating cardiovascular disease. The current guideline for cardiovascular disease diagnosis, which may be appropriate for males, is very likely to overlook a female patient with the same disease due to the reasons presented above. A modification to the guideline that can accommodate female patients is imperative.