In people with confirmed myocardial infarction do the manifestations of disorder differ in men and women? An integrative review

Aims and objectives: To identify the differences between men and women in the clinical manifestations of myocardial infarction. Background: Myocardial infarction presents in a number of clinical manifestations however, only a certain number of clinical symptoms have been highlighted as the indicating signs of someone experiencing a myocardial infarction. Design: Integrative literature review. Method: Three databases (MedLine, Embase and SCOPUS) were searched and each of the searches was limited to the English language. There was no date restriction. The ‘Users’ Guides to the Medical Literature XXIV, how to ‘Use an Article on the Clinical Manifestations of Disease’ wasused for quality assessment of the included studies. Results: A total of ten studies were identified that met the inclusion criteria. The studies consisted of a range of designs, four were cross-sectional studies, three were prospective studies, two were retrospective studies and only one was an observational study. Out of the 10 studies, six studies were found to have a low risk of bias while the remaining four were determined to be at a high risk of bias. Eight studies found that women were significantly older than men when they experienced a MI. Chest pain was documented across all of the studies and was the most commonly occurring symptom, particularly among men. All 10 studies reported on pain location and women were reported to experience pain in other areas aside from the chest such as, in the throat, neck, jaw, teeth, back and shoulders. Only one study reported chest pain to be more frequent in the female participants. Nine studies reported on symptomology in which, women were more likely to experience unusual fatigue, weakness, feelings of fear, vertigo, dizziness and syncope. Symptoms such as diaphoresis, anxiety and feelings of distress did not have any statistically significant differences between men and women. Only three studies documented and reported on the characteristics of MI associated pain however, there were no statistically discernable differences between men and women. Conclusion: Current literature suggests that although there is a plethora of clinical manifestations of myocardial infarction, only a number of these are considered as tell-tale signs. Men are more likely to present with the typical symptoms of myocardial infarction that individuals and health professionals are traditionally trained to recognise. However, because women are likely to present differently to their male counterparts, this causes a determinantal affect to their likelihood to be properly diagnosed, limits their access to treatment and management options and creates poorer health outcomes