Sex Differences in Patient-Reported Symptoms Associated With Myocardial Infarction (From the Population-Based MONICA/KORA Myocardial Infarction Registry)

Study Questions:

Do symptoms of acute myocardial infarction (AMI) differ among females, as compared to males?


The data for this study were collected as part of the World Health Organization Monitoring Trends and Determinants in Cardiovascular Disease (MONICA) project, a population-based registry implemented in 1984. In 1995, the MONICA registry was incorporated into the Cooperative Health Research in the Region of Augsburg (KORA). All cases of coronary deaths and nonfatal AMI from the study population (ages 25-74) residing in the city of Augsburg and two adjacent counties were recorded. For the present study, all registered patients from January 1, 2001 through December 31, 2006 with an incident AMI diagnosis were included. Occurrence of 13 AMI symptoms was recorded using standardized patient interviews, by trained study staff. Patients who were not interviewed were excluded from analysis, including those who died (n = 162), those who refused (n = 210), those who had poor German-language skills (n = 60), who were discharged early (n = 38), delayed case identification (n = 125), or poor health status (including impaired consciousness, n = 116). The initial question on AMI symptoms was, “Did you have pain in the chest or a feeling of pressure or tightness?” Patients were then asked if other symptoms and complaints had occurred. If they agreed, they were queried on the occurrence of 12 additional symptoms. The 12 symptoms were pain in the left shoulder, arm, or hand; pain in the right shoulder, arm, or hand; pain between the shoulder blades; pain in the upper abdomen; pain in the throat or jaw; nausea; vomiting; dizziness; syncope; dyspnea; diaphoresis; and fear of death.


A total of 568 women and 1,710 men, ages 25-74 years, hospitalized with a first-ever AMI, were included in the present analysis. The most common symptom reported was chest pain or feelings of pressure or tightness for both women (93.5%) and men (94.2%). After controlling for age, migration status, BMI, smoking, comorbidities including diabetes, and type and location of AMI, women were significantly more likely to complain of pain in the left shoulder/arm/hand (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.10-1.69), pain in the throat/jaw (OR, 1.78; 95% CI, 1.43-2.21), pain in the upper abdomen (OR, 1.39; 95% CI, 1.02-1.91), pain between the shoulder blades (OR, 2.22; 95% CI, 1.78-2.77), vomiting (OR, 2.23; 95% CI, 1.67-2.97), nausea (OR, 1.94; 95% CI, 1.56-2.39), dyspnea (OR, 1.45; 95% CI, 1.17-1.78), fear of death (OR, 2.17; 95% CI, 1.73-2.72), and dizziness (OR, 1.49; 95% CI, 1.16-1.91), as compared to men. Women were also more likely to report four or more symptoms (OR, 2.14; 95% CI, 1.72-2.66). No significant gender differences were observed for symptoms of chest pain, feelings of pressure or tightness, diaphoresis, pain in the right shoulder/arm/hand, and syncope.


The investigators concluded that women and men did not differ when reporting chief AMI symptoms of chest pain or feelings of tightness or pressure and diaphoresis. However, women were more likely to have additional symptoms.


This is an interesting study, which suggests that women commonly experience chest pain or pressure with AMI, but are also likely to have additional symptoms. A limitation to this study as well as other such studies includes the lack of symptom data on patients who are too ill to be interviewed. In addition, the delay in interviews (average time between admission and interview was 6 days) may influence the ability to recall accurately presenting symptoms. Hopefully, such recall bias would be similar for both men and women.

Clinical Topics: Heart Failure and Cardiomyopathies

Keywords: Nausea, Registries, Myocardial Infarction, Dizziness, Chest Pain, Dyspnea, Health Status, Diabetes Mellitus, Consciousness

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