Title:Atypical Chest Pain in ACS: A Trap Especially for Women
VOLUME: 22 ISSUE: 25
Author(s):Beatrice Ricci, Edina Cenko, Elisa Varotti, Paolo Emilio Puddu and Olivia Manfrini
Affiliation:Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna. Policlinico Sant'Orsola Malpighi, Padiglione 11, Via Massarenti 9 , 40138 Bologna, Italy
Keywords:Angina, acute coronary syndrome, myocardial infarction, atypical chest pain, atypical presentation.
Abstract:Not all acute coronary syndromes (ACS) exhibit the classic symptoms of chest
pain. The diagnosis of ACS in patients without typical chest pain is often challenging. These
patients are at increased risk for delayed or incorrect diagnosis, less aggressive treatment and
high in-hospital mortality. The association between diabetes mellitus and absence of chest
pain in ischemic heart disease is established. As well, it is known that women, more frequently
than men, have atypical presentation. However, there is a lack of standardization in
characterizing the population of patients with ACS and atypical presentation. The identification
of other factors influencing and/or related with the absence of chest pain in ACS could
be helpful for patients’ outcomes. The object of our study was to examine the current literature
on the clinical features, other than female gender and diabetes, associated with the atypical
presentation of ACS. We found that patients with non-ST-elevation ACS more frequently
than patients with ST-elevation myocardial infarction have atypical presentation. Atypical
symptoms in aged population are common both among female and male. Subjects with history of comorbidities,
specifically heart failure, chronic kidney disease, chronic obstructive pulmonary disease and stroke are less likely
to report chest pain as chief complain of ACS.
