Senior Scholars Program

UMMS Affiliation

Department of Emergency Medicine

Faculty Advisor

Darling, Chad E.

Contributor(s)

Longo, Craig L.; Przyklenk, Karin

Date

6-1-2007

Document Type

Poster

Medical Subject Headings

Chest Pain; Myocardial Ischemia; Pain Measurement; Sex Factors; Diabetes Complications; Emergency Medicine; Diagnosis; Massachusetts

Disciplines

Cardiology | Emergency Medicine | Health Services Research

Abstract

Background: There is evidence of gender and diabetes-related differences in symptoms of ACS upon presentation to the ED: i.e., non-diabetic men typically report ‘chest pain’, whereas women and diabetics may report atypical complaints such as arm or jaw pain, nausea, etc. This may reflect differences in either ACS-related chest pain, or differences between men vs. women in the perceptionof pain.

Objective:Our aim was to obtain insight into this issue by comparing the frequency of broadly defined, ‘chest-associated discomfort’ rather than ‘chest pain’ reported by men vs. women and diabetics vs. non-diabetics with MI.

Methods:This is a prospective, ongoing, IRB-approved study enrolling patients presenting to an urban academic medical center with the subsequent diagnosis of NSTEMI/STEMI. After admission patients were interviewed using a focused, semi-structured format and queried as to the presence (yes/no), severity, and quality of chest discomfort–defined as any symptom referred to the thorax–upon ED presentation. Severity was scored on a scale of 1 to 10; the quality was categorized as: pressure or tightness; burning or ‘heartburn’; sharp or shooting sensation; cramping; or other. Patients were excluded if unstable or otherwise unable to give a history. Incidence of discomfort was compared in women vs. men by Fisher’s exact test, while severity was compared by t-test.

Results:Interim analysis of the 81 patients enrolled to date reveals no significant gender-related differences in either the incidence (91% in females versus 94% in males: p=0.69) or severity of chest discomfort (mean score of 7.4±2.8 in females versus 7.2±2.4 in males; p=0.76). Also no significant diabetes-related difference in either the incidence (86% in diabetics vs. 95% in non-diabetics, p=0.18) or severity (6.8±2.9 in diabetics vs. 7.4±2.4 in non-diabetics, p=0.34) of chest discomfort was found.

Conclusion:These preliminary results suggest that, while there may be gender or diabetes-related differences in the perception of ‘chest pain’, there is an equivalent incidence and severity of ‘chest discomfort’ in all groups. This re-enforces the importance of pursuing broad complaints of chest discomfort in the ED.

Comments

Alternate title: ED Diagnosis of ST-Elevation Myocardial Infarction: Confounding Effects of Gender and Diabetes.

Coverage

Massachusetts

Share

COinS
 
 

To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.