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Editor's Note |

Debunking Atypical Chest Pain in Women Comment on “Reconstructing Angina: Cardiac Symptoms Are the Same in Women and Men”

Rita F. Redberg, MD, MSc
JAMA Intern Med. 2013;173(9):752. doi:10.1001/jamainternmed.2013.1187.
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Awareness campaigns for heart disease in women have led to increased recognition for women of the importance of preventing heart disease via healthy lifestyle choices and recognizing the symptoms of heart disease. There also has been focus on the idea that women somehow present differently than men with ischemic coronary artery disease (CAD). Kreatsoulas et al reassure us that women and men are more alike than we think in presentation of CAD, and both are most likely to experience chest pain, pressure, and tightness. It is likely that atypical symptoms represent women who do not have ischemic CAD. These findings should be a great relief to the many women who have been concerned that they could be having a myocardial infarction unbeknownst to them because they would not get the typical warning symptoms of chest pain.


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Unconscious Cultural Biases Narrow Diagnostic Lens Focused On Women
Posted on May 17, 2013
Stuart Garrie, M.D.
Conflict of Interest: None Declared
Through personal experience in 35 years of previous Dermatology and Psychiatry practice plus going to doctors with my wife, I have noted a propensity towards diagnosing women as having anxiety and or depression when the physician does not know the diagnosis--would perhaps telling women I don't know the etiology of your symptoms be more scientific? For example, instead of the cardiologist taking a history regarding my wife seeing him for a new onset rapid heart rate, she was immediately diagnosed as having a panic reaction; an electrocardiologist eventually diagnosed her as having paroxysmal atrial tachycardia. Is the unconscious bias, "she is female, thus the etiology must be emotional." This initial cardiologist diagnosed panic disorder without taking a history for panic disorder. I don't think my wife's experience is atypical for women. Unfortunately the lack of taking a history is a diagnostic tragedy for both men and women--could this unconscious diagnostic bias be in large part due to training professors now emphasizing the diagnostic procedures and testing more than listening to the patient and asking the patient pertinent questions from our knowledge of pathophysiology?
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