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.