Atypical Chest Pain in ACS: A Trap Especially for Women

Area of Science:

• Cardiology
• Internal Medicine
• Clinical Research

Background:

• Acute coronary syndromes (ACS) often present atypically, challenging diagnosis and increasing mortality risk.
• While diabetes and female gender are known factors, other influences on atypical ACS presentation require characterization.
• Standardized identification of patients with atypical ACS is lacking, impacting treatment and outcomes.

Purpose of the Study:

• To review literature identifying clinical features associated with atypical ACS presentation, excluding female gender and diabetes.
• To explore factors contributing to the absence of chest pain in patients with acute coronary syndromes.
• To improve diagnostic accuracy and patient outcomes for ACS presenting without typical chest pain.

Main Methods:

• Systematic literature review of studies on acute coronary syndromes (ACS) with atypical presentations.
• Analysis of clinical features and patient demographics associated with the absence of chest pain in ACS.
• Focus on factors beyond established associations like diabetes mellitus and female gender.

Main Results:

• Non-ST-elevation ACS (NSTEMI) patients more frequently exhibit atypical presentations compared to ST-elevation myocardial infarction (STEMI).
• Atypical symptoms are common in the elderly population, irrespective of gender.
• Comorbidities such as heart failure, chronic kidney disease, COPD, and stroke are linked to a lower likelihood of reporting chest pain in ACS.

Conclusions:

• Clinical factors beyond diabetes and gender, including specific comorbidities and ACS type, are crucial for identifying atypical presentations.
• Recognizing these factors can help clinicians diagnose ACS more effectively in patients without classic chest pain.
• Further research into atypical ACS presentations can lead to improved diagnostic strategies and patient management.