DISCUSSION
Studies demonstrate an atypical presentation to the ED for women with new-onset non-traumatic chest pain . Women present with more nausea and vomiting , less pain on exertion , less right-sided chest pain , and more pleuritic chest pain . 8 They also present more often with hypercholesterolemia / hyperlipidemia . 9 Contributing to their atypical presentation is their electrocardiogram abnormalities , hypertension , and that they are less likely to be diagnosed with myocardial infarction than males . 2-5 , 7 Women are found to die from coronary artery disease more often than males although males have a higher incidence .
Women present having already been prescribed more medications and are more often found to be on steroids and antidepressants , which increases the likelihood to be diagnosed with a psychiatric or psychomotor disorder . 2 A gender bias is noted for cardiac monitoring , angioplasty , and nitroglycerin treatment . Nitroglycerin treatment has been more often in males in the past , but more recently nitroglycerin use is seen slightly more in women . 2 , 9 Women more often present to the ED already on pulmonary medications , while males are prescribed pulmonary medications in the ED . 2 Males were reported to more often be on antibiotics at home and in the hospital , but in this follow-up study , women were more often on antibiotics at home and less often at the hospital . The difference of antibiotic use in women can be attributed to their less aggressive treatment in comparison to males who more often get a more comprehensive cardiovascular workup . 2
Our findings showed remarkable improvement compared to the study by Lehmann et al ., which reported that women received fewer electrocardiograms and fewer women underwent cardiac monitoring as well as lactic dehydrogenase isoenzyme and creatine kinase-MB testing . 2 Statistically significant more women receiving nitroglycerin compared to men , which was a stark contrast to the study by Lehmann et al . where men were more likely to receive nitroglycerin , acetylsalicylic acid , heparin , and tissue-type plasminogen activator . Our study also found that men were more likely
Location of chest pain Anterior chest / chest wall Epigastric Generalized Sub-sternal Left-sided Right-sided
Quality of pain Radiation of pain Reproducible musculoskeletal pain Pleuritic chest pain Pain on palpation + movement Pain relief with nitroglycerin
Related symptoms Dyspnea Nausea / vomiting Diaphoresis Dizziness Heartburn ( reflux ) Anxiety
* P values < 0.05 . Values are expressed as number (%)
TABLE 3 . Home medications ( n = 375 )
* P values < 0.05 . Values are expressed as number (%)
Men ( n = 179 ) Women ( n = 196 ) Anti-hypertensive medications 63 ( 35 %) 79 ( 40 %) Analgesics 44 ( 24 %) 67 ( 34 %) Hormones 3 ( 2 %) 44 ( 22 %)* Anxiolytics 11 ( 6 %) 12 ( 6 %) Pulmonary medications 24 ( 13 %) 43 ( 22 %)* Gastrointestinal medications 53 ( 30 %) 76 ( 39 %) Anticoagulants 21 ( 12 %) 25 ( 13 %) Diabetes medications 27 ( 15 %) 31 ( 16 %) Nitroglycerin 6 ( 3 %) 19 ( 10 %) Acetylsalicylic acid medications 37 ( 21 %) 43 ( 22 %) Steroids 3 ( 2 %) 7 ( 4 %) Other medications 30 ( 17 %) 28 ( 4 %)
to be admitted to the intensive care unit or the cardiac step-down unit . There was also no statistically significant difference between women and men receiving an emergency cardiology consultation , aspirin , heparin , antibiotics , anxiolytics , emergency catheterization , or thrombolytic agents an improvement to the findings in the prior
TABLE 2 . Presenting symptoms ( n = 375 ) Men ( n = 179 ) Women ( n = 196 )
10 ( 6 %) 1 ( 0.5 %) 72 ( 40 %) 25 ( 14 %) 55 ( 31 %) 16 ( 9 %)
179 ( 100 %) 41 ( 23 %)* 41 ( 23 %) 7 ( 4 %) 13 ( 7 %)
36 ( 20 %) 20 ( 11 %) 5 ( 2 %) 11 ( 6 %) 6 ( 3 %) 12 ( 7 %)
study by Lehmann et al .
4 ( 2 %) 0 ( 0 %) 98 ( 50 %) 28 ( 14 %) 50 ( 26 %) 16 ( 8 %)
196 ( 100 %) 29 ( 15 %) 48 ( 24 %) 7 ( 4 %) 17 ( 9 %)
45 ( 23 %) 13 ( 7 %) 3 ( 1.5 %) 9 ( 5 %) 2 ( 1 %) 12 ( 6 %)
There were seven statistically significant differences reported in this cohort . Women were more likely to have a pulse rate > 100 bpm . Women had less reproducible musculoskeletal pain and more OTC medicine use as well as greater use of hormone and
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