Department of Emergency Medicine
Darling, Chad E.
Cardiology | Emergency Medicine | Health Services Research
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.
Chest Pain, Myocardial Ischemia, Pain Measurement, Sex Factors, Diabetes Complications, Emergency Medicine, Diagnosis, Massachusetts
Rights and Permissions
Copyright is held by the author(s), with all rights reserved.
DOI of Published Version
Senior Scholars Program
Longo, Craig L.; Przyklenk, Karin
Biegun, Garreth C., "ED Diagnosis of Acute Coronary Syndromes: No Gender-Related Difference of 'Chest Discomfort'" (2007). University of Massachusetts Medical School. Senior Scholars Program. Paper 42.