Gender Differences in Symptoms of Myocardial Ischaemia

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Final version published as: 

Mackay, M.H., Ratner, P.A., Johnson, J.L., Humphries, K.H., Buller, C.E. Gender differences in symptoms of myocardial ischaemia. European Heart Journal 32 (24). 2011. 3107–3114.

Date created: 
DOI: 10.1093/eurheartj/ehr358
Acute coronary syndrome
Acute myocardial infarction
Sex and gender differences


Better understanding of symptoms of myocardial ischaemia is needed to improve timeliness of treatment for acute coronary syndromes (ACS). Although researchers have suggested sex differences exist in ischaemic symptoms, methodological issues prevent conclusions. Using percutaneous coronary intervention (PCI) balloon inflation as a model of myocardial ischaemia, we explored sex differences in reported symptoms of ischaemia.

Methods and results

Patients having non-emergent PCI, but not haemodynamic instability or left bundle branch block or non-acute coronary occlusion, were prospectively recruited. Pre-procedure, descriptions of pre-existing symptoms were obtained using open-ended questioning. Inflation was maintained for 2 min or until moderate discomfort or clinical instability occurred. During inflation, subjects were exhaustively questioned about their symptoms. Concurrent ECG data were collected. The final sample was 305 [39.7% women; mean age 63.9 (±10.6)]. No sex differences were found in rates of chest or typical ischaemic discomfort, regardless of ischaemic status. Women were significantly more likely to report throat/jaw discomfort [odds ratio: 2.91; 95% confidence interval: 1.58–5.37] even after statistical adjustment for clinical and demographic variables.


This prospective study with ECG-affirmed ischaemia found no statistically significant differences in women's and men's rates of chest and other typical symptoms during ischaemia, although women were more likely to experience throat and jaw discomfort. Currently both popular press and some patient education materials suggest women experience myocardial ischaemia differently from men. Steps to ensure women and health professionals are alert for the classic symptoms of myocardial ischaemia in women, as well as men, may be warranted.

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Rights remain with the authors.
British Columbia Medical Services Foundation
Canadian Institutes of Health Research (CIHR)
Michael Smith Foundation