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American Journal of Critical Care. 2008;17: 14-24
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CE Article

Symptoms Across the Continuum of Acute Coronary Syndromes: Differences Between Women and Men

By Holli A. DeVon, RN, PhD, Catherine J. Ryan, RN, PhD, APRN, CCRN, Amy L. Ochs, BSN and Moshe Shapiro, MS. Holli A. DeVon is an associate professor and Amy L. Ochs is a research assistant at Niehoff School of Nursing, Loyola University Chicago, Maywood, Illinois. Catherine J. Ryan is a research assistant professor at the University of Illinois at Chicago. Moshe Shapiro is a bio-statistician at Hines VA Hospital, Hines, Illinois.

Corresponding author: Holli A. DeVon, RN, PhD, Loyola University Chicago, Niehoff School of Nursing, 2160 S First Ave, Bldg 105, Maywood, IL 60153 (e-mail: hdevon{at}luc.edu).

Background The urgency and level of care provided for acute coronary syndromes partially depends on the symptoms manifested.

Objectives To detect differences between women and men in the type, severity, location, and quality of symptoms across the 3 clinical diagnostic categories of acute coronary syndromes (unstable angina, myocardial infarction without ST-segment elevation, and myocardial infarction with ST-segment elevation) while controlling for age, diabetes, functional status, anxiety, and depression.

Methods A convenience sample of 112 women and 144 men admitted through the emergency department and hospitalized for acute coronary syndromes participated. Recruitment took place at 2 urban teaching hospitals in the Midwest. Data were collected during structured interviews in each patient’s hospital room. Forty-eight symptom descriptors were assessed. Demographic characteristics, health history, functional status, anxiety, and depression levels also were measured.

Results Regardless of clinical diagnostic category, women reported significantly more indigestion (β = 0.25; confidence interval [CI] = 0.01–0.49), palpitations (β = 0.31; CI = 0.06–0.56), nausea (β = 0.37; CI = 0.10–0.65), numbness in the hands (β = 0.29; CI = 0.02–0.57), and unusual fatigue (β = 0.60; CI = 0.27–0.93) than men reported. Differences between men and women in dizziness, weakness, and new-onset cough did differ by diagnosis. Reports of chest pain did not differ between men and women.

Conclusions Women with acute coronary syndromes reported a higher intensity of 5 symptoms (but not chest pain) than men reported. Whether differences between the sexes in less typical symptoms are clinically significant remains unclear.

Notice to CE enrollees:
A closed-book, multiple-choice examination following this article tests your understanding of the following objectives:
  1. Describe acute coronary syndromes.
  2. Recognize how symptoms differ in women and men with acute coronary syndromes.
  3. Understand the results, strengths, and limitations of this study.
To read this article and take the CE test online, visit www.ajcconline.org and click "CE Articles in This Issue." No CE test fee for AACN members.


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