A Review of the Literature on Cardiac Symptoms in Older and Younger Women

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To describe acute and prodromal cardiac symptoms in older and younger women.

Data Sources:

PubMed, CINAHL, MEDLINE, and Web of Science databases were searched for articles published between January 2000 and January 2015.

Study Selection:

A combination of the MESH terms acute coronary syndrome, myocardial infarction, symptoms, prodromal symptoms, sex, gender, and age was used. The search was limited to studies on humans published in English and original articles related to symptoms of acute coronary syndrome (ACS) in women with symptoms stratified by age or analyses adjusted for age and/or sex.

Data Extraction:

A total of 432 articles were identified, and 20 met the inclusion criteria.

Data Synthesis:

Key findings for differences in acute ACS symptoms for women based on age included the following: (a) typical chest pain and pain of any kind were less likely in older women (≥65 years); (b) women were more likely to have nonpain symptoms of nausea, dyspnea, and fatigue after adjustment for age; (c) most researchers did not adjust for menopausal status or hormone replacement therapy; and (d) findings were consistent across international cohorts. The most common prodromal symptoms in women after adjustment for age included unusual fatigue, discomfort in arms, sleep disturbance, anxiety, general chest discomfort, discomfort in jaws/teeth, and shortness of breath. Although chest symptoms were reported by some women, they were not reported by most women.


Women older than 65 years with ACS experienced fewer symptoms, more ambiguous symptoms, less chest pain, and more dyspnea. Women older than 50 years were more likely to report prodromal symptoms that include sleep disturbance. Many symptom differences that were statistically significant by age, such as chest pain and shortness of breath, may not be clinically relevant.

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