CHEST PAINS IN THE RISK GROUP-GENDER DIFFERENCES IN PRESENTATION AT PRIMARY CARE

We have always struggled with chest pains in females in the risk groups because they are often atypical. We have always attributed it to the fact that females are smaller in size and so their arteries are also smaller. This maybe true to a certain extend. Coronary flow restriction becomes more obvious by lesser narrowing and by fixed ( atherosclerotic plaque ) narrowing and also by some degree of coronary spasm, on top of the fixed narrowing.
I happen to browse over in medscape, an article published in the Dec 14th 2009, online edition of BMC family practice ( BioMed Central family practice , an article published on-line by a German team, Dr Haassenritter et al from University of Marsburg, a study that they carried out on coronary chest presentation, amongst German females presented to 74 pprimary care clinics. A total of 1212 patients were studied.
The authors found that there seemed not much difference in presentation between the sexes, except that females tend to have more associated psychogenic disorders, and that their chest pains seem to last longer. Males with cardiogenic chest pains tend to have pains which last about 30 mins or less then 1 hour, whereas females tend to have chest pains which last 1 - 12 hours typically. Females tend to have chest pains brought on by emotional upsets, more often. Also, females are less often smokers, although I suspect that this may change, with the increasing number of females who take up smoking in this country.
I suppose, these findings go well with our initial understanding that females with smaller arteries and a higher spasm component, tend to have longer lasting chest pains and emotion plays a greater part.
I must say that this is also what I notice here. Females still have exertional angina, but there is usually a higher emotional component, and they tended to last longer, although for me, 12 hours is way too long. I have seen coronary angiograms of females with chest pains where the artery wall have minimal atherosclerosis, but had a very high incidence of spasm, documented angiographically. In fact, one patient had total occlusion of her right coronary artery due to spasm, which was relieved by IV nitroglycerin.
There are gender differences and we need to be more aware. The fact the more females are having diabetes, and their presentation can be even less typical.