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A recent study in JAMA has provided further evidence regarding some key issues in ACS/MI presentations which seem to be commonly taught but often forgotten in actual practice. Here's just a few of the key findings from this study:
1. Generally speaking, women were more likely to present without chest pain than men, and the difference between the sexes was most apparent in the < 45yo groups. Overall, 42% of women presented with painless MIs. [remember from a recent prior cardiology pearl that painless MIs have a higher mortality as well]
2. Women had a higher mortality than men within the same age groups, and the difference between the sexes was most apparent in younger ages.
3. Almost 1/5 of women < 45 yo with MI did not report chest pain. [We've always assumed it's just the older women that present with painless MIs....not true!]
A final point that should be re-stated: young women DO have MIs, they DO often present without pain, and they DO often die. Be wary.
References
Canto JG, et al. Association of age and sex with myocardial infarction symptom presentation and in-hospital mortality. JAMA 2012;307:813-822.