Which group is more likely to present acute coronary syndromes without chest pain?

Which group is more likely to present acute coronary syndromes without chest pain?

• A. Young men
• B. Elderly men
• C. Females
• D. Athletes

Answer: (C)

Atypical or nonclassic symptoms are more common in females with acute coronary syndromes. While many people think of ACS as chest pressure or squeezing pain, women often experience other signs such as shortness of breath, fatigue, nausea, dizziness, back or jaw pain, or upper abdominal discomfort. This can occur with or without chest pain, making ACS harder to recognize if clinicians expect the classic chest symptoms. The reason this fits females is that there are gender-related differences in how ischemia manifests. Hormonal and physiological factors, along with a higher likelihood of microvascular dysfunction and nonobstructive disease in some women, contribute to symptoms that aren’t the stereotypical chest pain. Because of this, women presenting with these other symptoms, especially if they have cardiovascular risk factors, should still be evaluated for ACS. So among the groups listed, females are the one most likely to present with acute coronary syndromes without chest pain. Young men and athletes typically report chest pain with exertion, while elderly men may also have chest symptoms but are not as disproportionately associated with non-chest presentations as women are.

Atypical or nonclassic symptoms are more common in females with acute coronary syndromes. While many people think of ACS as chest pressure or squeezing pain, women often experience other signs such as shortness of breath, fatigue, nausea, dizziness, back or jaw pain, or upper abdominal discomfort. This can occur with or without chest pain, making ACS harder to recognize if clinicians expect the classic chest symptoms.

The reason this fits females is that there are gender-related differences in how ischemia manifests. Hormonal and physiological factors, along with a higher likelihood of microvascular dysfunction and nonobstructive disease in some women, contribute to symptoms that aren’t the stereotypical chest pain. Because of this, women presenting with these other symptoms, especially if they have cardiovascular risk factors, should still be evaluated for ACS.

So among the groups listed, females are the one most likely to present with acute coronary syndromes without chest pain. Young men and athletes typically report chest pain with exertion, while elderly men may also have chest symptoms but are not as disproportionately associated with non-chest presentations as women are.