Do women and men experience different symptoms with acute coronary syndrome (ACS)? If differences exist, are they sufficient to warrant a different public health message? Should clinicians factor in sex when trying to diagnose ACS in the emergency department? Do other patient characteristics (such as age, race, or the presence of diabetes) significantly affect clinical presentation?
These questions are important in an era when the American public has become increasingly aware that ACS is not a male disease and women proudly wear a pin shaped as a red dress to demonstrate their vulnerability to heart disease.1 Physicians have been sensitized to the potential of a missed diagnosis of ACS, often through personal experience with 1 or more female patients who delayed seeking treatment for hours or even days, thereby postponing life-saving treatment. On average, women experience a longer time interval than men between the onset of acute symptoms and receipt of emergency care.2 Many factors may contribute to the longer times documented in women compared with men such as misattribution of symptoms, symptom uncertainty, mismatch between expectations and reality, fear of bothering anyone, desire to avoid embarrassment regarding consequences of care seeking, and reluctance to call emergency medical services.3,4 But the reality of this difference between men and women in prehospital delay to treatment time contributes to the significance of identifying typical ACS symptom presentation in women and educating the public accordingly.
Thank you for submitting a comment on this article. It will be reviewed by JAMA Internal Medicine editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 12
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
All results at
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.