The prevailing notion has been that women present with symptoms of angina that are “atypical” from men – headaches, jaw pain, generalized malaise – rather than definitive anginal-type chest pain or pressure. These authors would like to suggest this global characterization is incorrect.
These authors enrolled a sample of 128 men and 109 women who underwent coronary angiogram following an abnormal stress test. Patients with obstructive coronary artery disease on their angiogram were surveyed regarding the symptoms that prompted them to seek care. Of this cohort, 89 men had obstructive disease compared with 50 women.
Overall, there was no significant statistical difference in the rate of most descriptors used by men or women. Surprisingly, women were statistically more likely to use “typical” terms such as “discomfort”, “crushing”, “pressing” and “aching” to describe their chest pain. Therefore, these authors conclude the clinical construct of “atypical angina” in women is incorrect.
I would tend to agree – excepting their study suffers from selection bias. If patients are only referred for testing due to suspected coronary artery disease, then the population with “atypical” symptoms might not be fully captured. That being said, it does look as though the female population in their study encompassed a number of patients who potentially were referred for atypical symptoms, considering the yield of their coronary angiography was much lower in women. It would have been interesting to compare the referral symptoms to the subset with demonstrated obstructive CAD.
“Reconstructing Angina: Cardiac Symptoms Are the Same in Women and Men”
www.ncbi.nlm.nih.gov/pubmed/23567974