Sex differences in chest pain and prediction of exercise-induced ischemia.
OBJECTIVE
To examine sex differences pertaining to pain characteristics in patients presenting to the ambulatory emergency department (ED) with nontraumatic chest pain and to the prediction of exercise-induced ischemia on a follow-up electrocardiogram.


METHODS
This was a prospective study of 131 women and 202 men (mean age 58 years) consulting the ED with a chief complaint of chest pain. Seventy-eight women and 116 men underwent exercise stress testing following the ED consultation. Chest pain location, extension, intensity and quality were measured. Chest pain was classified as nonspecific, or typical or atypical of angina.


RESULTS
Women received fewer 'typical' angina pain diagnoses (P<0.05), rated their pain as more intense (P<0.05) and used more affective words to describe their pain (P<0.05) compared with men. Pain in the posterior shoulder and middle back areas were more frequently reported by women (P<0.05). The presence of pain in the right anterior and posterior shoulder, as well as the absence of pain in the left anterior shoulder, predicted ischemia (P<0.05) in both men and women. Only in men, pain in the retrosternal and right middle back areas, as well as a classification of pain as typical or atypical, further contributed to the prediction of ischemia.


CONCLUSIONS
Sex differences exist in the experience of chest pain and in the prediction of exercise-induced ischemia from pain variables. Further research on the unique symptomatology of men and women is needed to optimize their medical management.
D'Antono
Bianca
B
Montreal Heart Institute and Department of Psychology, University of Québec in Montréal, Montréal, Québec. bianca.d'antonio@internet.uqam.ca
Dupuis
Gilles
G
Fleet
Richard
R
Marchand
André
A
Burelle
Denis
D
D000787:Angina Pectoris / Q000503:physiopathology*; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D010147:Pain Measurement; D011446:Prospective Studies; D011792:Quebec; D012727:Sex Characteristics