Gender Differences in Myocardial Infarction

Abstract

Many studies have been done to establish if there are gender differences in patients having a myocardial infarction. This paper looks at various literature materials written on the same topic. After the introduction, there is a review of various studies that have been done to establish if there are gender differences in patients having a myocardial infarction. A study on gender differences in patients with Major Depressive Disorder is also included in the review to give a parallel picture from a different discipline. The outcomes of the studies are then synthesized and the major points outlined.

The major points are then integrated to give a clear outcome of the reviews as a whole. From the review, it has been established that there are some significant gender differences in patients having a myocardial infarction. The implications of the findings are then discussed and suggestions are given to improve the situation. The conclusion section then summarizes the main points of the paper.

Gender Differences in Patients Having a Myocardial Infarction

Nursing is an essential profession in ensuring that the health of individuals within a society is maintained at a stable state. In the medical setting, all the patients need to be in the hands of competent staff that will ensure that they have a quick recovery. These staff should be competent in terms of care and supervision. They should be able to monitor the progress of their patients, detect any irregularities and prescribe medication to improve their condition. Thus, they should be able to identify the roles of surgeons, doctors, and other caregivers in the hospital setting. To determine their competence, nurses should exhibit a clear understanding of core mental health principles, health practices, and role boundaries.

It has always been hypothesized that the impact that health conditions have on male patient vary as compared to that of female patients. Due to this fact, several studies have been conducted in the medical discipline to determine this fact. These studies have been essential since they increase the information with regards to the available knowledge on various illnesses that pose a threat to the human population. Myocardial infarction has been one of the leading causes of death in the western world for several decades now. The condition has been studied extensively, and it has long been established that there are several gender-based differences in patients with myocardial infarction.

These differences have been shown in the clinical presentation, the response to various treatment options, and the manner of recovery after treatment has been administered following an attack. Many different studies have been done to demonstrate the differences in various aspects of the condition. Most of the findings from these studies have been inconsistent, mainly because they have used different study populations, and other factors are not constant for each study yet they have a significant influence on the manifestation and outcome of myocardial infarction in both genders.

The implications of all these studies have a very significant impact on nursing care for patients who have suffered myocardial infarction as they form the basis for treatment and monitoring. With gender differences being demonstrated in various aspects of the condition including the pathological presentation, the response to treatment, and the recovery patterns, it is clear that different approaches may have to be adopted for treatment and management based on gender differences. This paper will review different studies that have been conducted on the subject and published in various nursing journals. It will also review one study from the field of psychology to help establish that indeed there are gender differences in patients having a myocardial infarction.

Review of Relevant Literature

Gender differences in trends of acute myocardial infarction events: The Northern Sweden MONICA study by Dan Lundblad, Lars Holmgren, Jan-Hakan Jansson, Ulf Naslund, and Mats Eliasson

The purpose of this study was to analyze the differences between men and women when it comes to the initial attack and the recurrent events thereafter. The study also looked at the case fatality and the rates of mortality in patients with myocardial infarction based in northern Sweden. This was a retrospective study based on data collected during the WHO Monitoring Trends and Determinants in Cardiovascular Disease (MONICA) project from 1985 to 2004.

The total number of reported cases of myocardial infarction cases recorded during that period for subjects aged 25-64 years was 11, 763 (Lundblad et al, 2008). The study carefully monitored and analyzed all hospital records, doctors’ reports, and death certificates related to myocardial infarction. The study used strict WHO criteria to verify the medical history, clinical presentation, electrocardiograms (ECGs), and cardiac enzymes. The personnel used for the study were specially trained nurses under the supervision of physicians.

The diagnosis of myocardial infarction for the study was based on characteristic chest pain and biomarkers, and in cases where only one of these was positive, the ECG was also analyzed to give a more definite diagnosis. The subjects who survived the initial attack were categorized as definite MI or non-MI, while those who died within 28 days after the initial attack were classified as fatal cases. The fatal cases encompassed those who died before reaching the hospital, those who died in hospital, and those discharged alive but went on to die within 28 days. Patients whose history indicated no previous case of clinically recognized myocardial infarction were regarded as first-time cases, while the others were termed as recurrent cases. The frequency of deaths from myocardial infarction based on statistics from death certificates was 56.4% for men and 54.1% for women (Lundblad et al, 2008).

The continuous data from the experiment were analyzed using SPSS software and presented as the mean and standard deviation. The population of men targeted in the study was between 132,000- 140,000 while for women it was between 126,000- 131,000 during the period. The researchers used direct age standardization for total events and mortality. The results revealed that the number of male subjects was almost four times more than that of females. Both groups showed a decline of cases as the years passed, with men dropping from 1181 (1985-1987) to 827 (2003-2004), and women 391 (1985-1987) to 248 (2003-2004).

There were a higher proportion of women presenting with myocardial infarction for the first time in all cases as compared to the men (73.8 % for women, 67.0% for men). The average age of women presenting with both first and recurrent myocardial infarction was approximately 1 year higher than men (Lundblad et al, 2008). The men presented with a slightly higher case fatality for both first and recurrent myocardial infarction.

Sex Difference of In-hospital Mortality in Patients with Acute Myocardial Infarction by Teruo Shiraki and Daiji Saito

This study involved 1,354 patients of both sexes, and the researchers compared the clinical characteristics of these patients when they were admitted and the in-hospital outcome. The main aims of the study were to determine whether MI has a worse in-hospital outcome for women than men and if so, to determine if it was related to age. The average age for admission was 7 years higher for women than men, and the women suffered in-hospital deaths more frequently than men (Shiraki & Saito, 2011). The in-hospital outcome was also established to be worse for women after an acute attack of myocardial infarction.

This was a retrospective study using data obtained from the 1,354 consecutive patients admitted at Iwakuni Clinical Center in Japan. The researchers obtained the clinical history, physical examination, laboratory data, and the ECGs of all the patients immediately after they were admitted. The ECG and various markers were measured regularly while the patients were in the hospital. The researchers used SAS software to analyze the data. There were 942 male patients in the study with a mean age of 65 ± 12 while the women were 412 with a mean age of ± 11 years. In the hospital, deaths were recorded in 14% of women as compared to 8% of men (Shiraki & Saito, 2011).

Cases of previous myocardial infarction were more likely in men than in women. Other related conditions like diabetes, stroke, and hypertension showed similar frequency with both sexes. When they were hospitalized, a total of 130 patients died, 74 were men while 56 were women (Shiraki & Saito, 2011). After a thorough analysis of different variables as presented in the results, the study was able to demonstrate that women had a significantly worse in-hospital outcome than men. The study concluded that sexually different factors were responsible for the higher in-hospital mortality in females.

Recognizing myocardial infarction in women Zbierajewski-Eischeid, Samantha J. and Loeb, Susan J.

In this retrospective study, the authors analyzed 16 journal articles on the atypical presentation of myocardial infarction in women. From the analysis, it was established that only about half of the women who suffered myocardial infarction presented with chest pain. The study revealed that women were more likely to present with atypical symptoms like upper abdominal and epigastric pain, back pains, difficulty in breathing, poor sleep patterns, general fatigue, and nausea (Zbierajewski-Eischeid & Loeb, 2010). It was established that women are also less likely to identify with a heart attack and will therefore not realize that the signs and symptoms they are exhibiting are those of a heart attack. Women have been shown to delay seeking medical treatment after experiencing symptoms of myocardial infarction and this contributes to their poor prognosis (Zbierajewski-Eischeid & Loeb, 2010).

From a comparative survey of 82 men and women, the authors were able to determine that women had more symptoms of heart attack than men. The study also revealed that women have more non-chest pain symptoms that may be deemed inconsistent with cardiac symptoms. Most of these atypical symptoms may be wrongfully identified as emotional, gastrointestinal, or musculoskeletal. In general, the women expected a heart attack to present with chest pain, so when they got the atypical symptoms they could not tell it was MI.(Zbierajewski-Eischeid & Loeb, 2010).

To reduce the chances of death occurring, the heart attack should be treated within the hour, so the atypical presentations put the women at a higher risk. The absence of chest pain was the main reason why the women delayed in seeking treatment. The analysis concluded that women delayed in seeking treatment for acute MI by an average of one hour more than men, and this is very significant to the prognosis (Zbierajewski-Eischeid & Loeb, 2010).

Are There Gender Differences in the Reasons Why African Americans Delay In Seeking Medical Help for Symptoms of an Acute Myocardial Infarction? Angela D. Banks and Kathleen Dracup

African Americans have been shown to have a higher overall mortality rate from MI than any other ethnic group (Banks & Dracup, 2007). African American men and women also delay in seeking treatment much longer than white men and women. The objective of this study was to identify the gender differences in the delay time and to outline the reasons why African Americans take much longer delays in seeking treatment after symptoms of acute MI. The design of the experiment was cross-sectional and it was set in five hospitals in the San Francisco and East Bay areas.

A total of 61 African American men and women diagnosed with acute MI were recruited for the study. The researchers obtained the exact times of the heart attacks by looking at the patients’ records and interviewing them. The researchers obtained demographic and medical characteristics by reviewing medical records and interviewing the patients. They also used questionnaires based on response to symptoms to get information like the setting in which the symptoms first appeared, what the patients were doing before the symptoms set in, emotional and behavioral response to the symptoms by the patients, and the response of others to the patients’ symptoms.

The data collected were analyzed using SPSS version 11.5 software, and the authors used descriptive statistics and frequencies to describe the sample. The median delay time was used to give a more accurate presentation of the delay time taken before arriving at the hospital. Of the total of 61 patients used for the study, 32 were women with a mean age of 61.5 ± 12 years, while the men were 29 in number with a mean age of 59.3 ± 12 years (Banks & Dracup, 2007). The women had less education than the men, with 41% college educated and 59% having reached high school education or less. For the men, 52% had a college education while 48% had a high school education or less (Banks & Dracup, 2007).

The overall median delay time was 4.3 hours, with women having a median delay time of 4.4 hours that was 0.9 hours longer than that of men at 3.5 hours. The results revealed that 69% of all the patients were at home when the symptoms set in. The men were more likely to be at home (79%) than the women (56%). The men at home when the symptoms started also had longer delay times (4.6 hours) than the men not at home (4.17 hours), while for women, no differences in delay time were seen based on their location at the onset of the symptoms (Banks & Dracup, 2007).

From the results, it was established that about half of the patients were delayed in seeking treatment after experiencing symptoms of acute MI. Instead of seeking medical help, most of the patients who were delayed were waiting for the symptoms to disappear on their own. Another common reason given was that they did not recognize the symptoms of a heart attack. In this study, 28% of the men and 47% of the women did not experience any chest pain when the symptoms set in, and this may have contributed to the delay in seeking treatment (Banks & Dracup, 2007). Most people expect a heart attack to present with chest pain so if it does not happen that way, they will not think of a heart attack. Both the men and women also experienced symptoms that came and went, and this reason contributed majorly to the delay in seeking treatment for the women. These stuttering symptoms reinforced the belief in the women that they were not having a heart attack.

Gender Differences in Symptoms of Myocardial Ischemia by Martha H. Mackay; Pamela A. Ratner; Joy L. Johnson; Karin H. Humphries; Christopher E. Buller

This prospective study was designed to explore the sex differences in reported symptoms of ischemia. The researchers targeted patients having a percutaneous coronary intervention with no associated side effects. After a rigorous elimination procedure, the researchers were left with a final sample of 305 participants on whom they conducted this study (Mackay et al, 2012). The researchers used open-ended questioning to get the pre-existing symptoms before the procedure.

The ECG data were also collected for analysis. The researchers used this controlled setting to help determine whether there are sex differences like symptoms produced by discrete episodes of ischemia. In the experiment, the ischemia was produced by the transient coronary occlusion during the administration of PCI. Participants were told about the intention of the study to examine the ischemic symptoms elicited by PCI but were not told of the sex-specific nature of the study to avoid any reporting bias (Mackay et al, 2012).

The researchers designed a standardized tool for questioning the patients regarding the location and intensity (on a scale of 0- 10) of symptoms that they associated with their heart to warrant angiography or PCI referral. The PCI was done as usual, but the balloon inflation was prolonged to a maximum of 2 minutes to cause symptomatic ischemia also recorded in the ECG. During the balloon inflation, patients were questioned again about the active symptoms using the designated tool. If the patient felt symptoms that were moderate to severe, or the ECG showed instability, the balloon inflation was stopped before two minutes.

The ECG was recorded at baseline, just before the balloon was inflated, during the inflation, and immediately after. The researchers then measured the ST-segment deviation of the ECG leads manually, and any ST deviation of 1 mm or more in any lead was considered ischemia (Mackay et al, 2012). The researchers then used descriptive statistics to analyze the sample, the number of symptoms reported, and the frequency with which they were reported. The sex differences in each of the symptoms were recorded and classified. All the factors that could influence the presentation of symptoms were analyzed thoroughly and their significance was noted. The researchers also trimmed the variables that were non-contributory to give a final model that had a minimum of 10 events per predictor variable. All the analyses were done using SPSS version 16.0.

From the results, 158 patients (51.8%) had the balloon inflated for more than 60 seconds (Mackay et al, 2012). There were no sex differences in the rates of complications. After analysis of those who had early deflation but no ischemia, the differences in frequencies between the sexes were not statistically significant. In other words, women were not more likely to record early deflation as compared to men for any reason other than ischemia confirmed by the ECG. There was also no significant difference in the number of symptoms reported by both genders during the inflation. The researchers concluded the frequency of chest discomfort as a result of ischemia and even other symptoms were just about the same for both sexes.

Specific and gender differences between hospitalized and out of hospital mortality due to myocardial infarction by Lina Mirić; Dinko Mirić; Darko Duplancić; Slaven Kokić; Dragan Ljutić; Valdi Pesutić; Viktor Culić; Damir Fabijanić; Marina Titlić

In this study, the researchers set out to evaluate the differences in mortality rates from myocardial infarction before and after hospitalization in both sexes. This prospective study was conducted at the Split Clinical Hospital and a total of 3434 patients were studied during the period between 2000 and 2006. Out of these, 2336 were males (68%) while 1098 (32%) were females. 427 patients died during the study, representing total mortality of 12%. There has been an increase in the total number of patients being admitted at the hospital, with 474 in the year 2000 and 547 in the year 2006. However, the mortality rate has decreased during the same period, with 15% in 2000 and 9.6% in 2006 (Miric et al, 2009). The researchers used SAS software to analyze the data.

From the study, female patients had a significantly higher hospital mortality rate (228 or 21%) than men (202 or 9%). Females also showed a higher total mortality rate from acute MI at 23.7% as compared to men at 15.7%. Further analysis revealed that more males and females died in hospital than out of the hospital. Men showed very high pre-hospital mortality rates at 81% as compared to women at 19%. The general conclusion from the study was that men die more frequently within the first few hours after a heart attack, while females die mostly in the subacute stage during hospitalization. In the end, the total mortality from myocardial infarction is still significantly higher in females (Miric et al, 2009).

Gender Disparity in Patients Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndromes- Rushd Jibran, Junaid Alam Khan, Angela Hoye

This was a retrospective study conducted from a dedicated database. The researchers analyzed all consecutive patients with Acute Coronary Syndrome (ACS) that were admitted at Castle Hill Hospital in the UK for PCI in the year 2008. The male patients were 331 in number while the females were 137 (Jibran et al, 2010). Baseline and procedural characteristics and complications were evaluated for both genders. From the results, the women were noted to be older at the time of presentation, with an average age of 66.1 ± 10.0, while the average age of the men was 60.7 ± 11.6 years. The baseline characteristics were generally similar for both groups. Smaller diameter stents were used to treat the female patients (2.86 ± 0.44 mm) as compared to the male patients whose diameter stents were 2.96 ± 0.5 mm. Despite these, the proportion of drug-eluting stents used for both groups was generally similar with 53.7% for females and 50.5% for males (Jibran et al, 2010).

The researchers used SAS software version 9.1 and noted that the male patients were more likely to receive optimal medical therapy. The female patients required less use of glycoprotein IIb/IIIa inhibitor (26.3%) as compared to the males (55.3%). The females also required less use of beta-blockers (83.9%) as compared to the males (90.9%). The progress of both sets of patients was closely monitored and at 30 days, it was noted that there were no differences in the rate of major adverse cardiac or cerebrovascular events (2.9% for females, 3.9% for males). However, the female patients had a higher rate of pseudoaneurysm at the femoral access site (4.4%) compared to the male patients at 0.9% (Jibran et al, 2010).

This study covered a total of 468 consecutive patients who underwent PCI in a tertiary referral center in the UK and reflects the contemporary practice at this level. From these findings, the researchers concluded that there is still evidence of continued gender disparity when it comes to providing treatment to patients with ACS and myocardial infarction. The age difference seen between the two genders at the time of presentation is common and can be explained by the delayed onset of coronary artery disease and myocardial infarction in women since estrogen is considered to have a cardioprotective effect (Jibran et al, 2010).

The biggest concern of the researchers is that females were still likely to receive less optimal health care. For example, few women in this study were treated with beta-blockers yet the benefits of such treatment are known to all physicians dealing with such cases. The female patients were also less likely to be treated with a glycoprotein IIb/IIIa inhibitor yet this powerful antiplatelet treatment helps in reducing adverse cardiac events in heart disease patients. This study confirms that even in hospital settings with the most modern techniques for PCI; women still do not get the best treatment possible as compared to men (Jibran et al, 2010).

Gender differences in psychological impairment after a coronary incident Veronika Brezinka, Stan Maes, and Elise Dusseldorp

The goal of this prospective study was to determine if there are any differences in psychological impairment between men and women who have suffered a myocardial infarction and other coronary incidents. The study chose subjects who had suffered a myocardial infarction (MI) or undergone coronary artery bypass grafting (CABG), coronary angioplasty (PTCA), or more than one of these. The researchers collected data from 231 patients (122 female and 109 male) who were all aged below 70 years. For the first measurement, the patients were interviewed by a team of experienced psychologists approximately 5 weeks after the coronary incident.

The second measurement was at 4 months after the incident and the third measurement was at 18 months after the incident. Out of the initial 231 patients, 222 of them completed the first and second measurements (female 119, male 103) and 177 (female 98, male 79) completed the third measurement (Brezinka, Maes & Dusseldorp, 2009). The researchers used three psychological questionnaires to measure psychological impairment. They then used univariate analyses to investigate gender differences in demographic and medical variables. The Mann-Whitney test was used for ordinal variables and continuous variables that were non-normally distributed. The researchers also used the Pearson chi-square test for categorical variables. The variable showing the biggest differences between men and women were investigated using multivariate analyses. The software used for all analyses was SPSS 8.0.

From the results, it emerged that female patients suffered more psychological impairment than their male counterparts. From the first measurement, the levels of vital exhaustion and social inhibition were significantly higher in females (70%) as compared to males (45%). This trend continued after the second measurement, though the men showed significantly higher levels of hostility. The trend also continued after the third measurement. The research was able to confirm that female patient who has suffered a myocardial infarction and other coronary incidences are at greater risk of suffering psychological impairment than their male counterparts (Brezinka, Maes & Dusseldorp, 2009).

Synthesis of Relevant Literature

All the literature that has been reviewed in this paper concerning the gender differences in patients with myocardial infarction gives a clear indication that, indeed, there are major differences that exist. Each of the studies reviewed was able to reveal the differences in the particular aspects that they set out to investigate. This paper has categorically highlighted these differences to form the basis for the better overall care of myocardial patients.

If there are ways through which some of these differences can be bridged, it is upon all the stakeholders in the medical fraternity to work towards achieving this so that all patients, both male, and female, get the best possible care. From study 1, it was clear that the proportion of women presenting with MI for the first time as compared to recurrent cases was much higher than that of men. The average age of women cases with MI was also slightly higher than that of men (Ludblad et al, 2008). Study 2 focused on in-hospital mortality and the general outcome after hospital admission for both sexes. It emerged that the average age for women admitted into hospital for MI was significantly higher than that of their male counterparts. The study also showed that more women die in hospitals after admission with MI than the men admitted for the same (Siraki & Saito, 2011).

Study 3 looked at the signs and symptoms of myocardial infarction as presented by both sexes. It focused especially on the atypical presentation in women, and how this affects them when it comes to getting medical help. Instead of presenting with chest pain as expected of MI, most of the women had atypical symptoms not necessarily associated with MI. This led them to delay in seeking medical help since they did not know they were having a heart attack (Zbierajewski-Eischeid & Loeb, 2010).

Study 4 set out to find out why African Americans in general and their women in particular, usually delay in seeking help when they are having a heart attack. The study established that both the men and women of black American origin had significant delays in seeking help, and the women delayed significantly longer than the men. The main reason for the delay was that they hoped the symptoms would go away. For many of the patients, the symptoms would come and go, and this is what convinced the women that they were not having a heart attack and caused the significant delay in seeking medical help (Banks & Dracup, 2007).

Study 5 focused on the symptoms of myocardial ischemia, especially the associated complications. From the results, it emerged that there were no significant differences between men and women when it came to complications associated with myocardial ischemia. Women were not more likely to develop complications than men. This was the one study reviewed that failed to find any significant differences between men and women on the particular detail that was under study (Mackay et al, 2012).

In study 6, the authors set out to evaluate the differences in the number of deaths associated with myocardial infarction in both men and women. They considered the number of patients who died both in and out of the hospital. The results showed that the total mortality was significantly higher in females. More women died in hospital than men. The men were more likely to die within the first few hours after an attack, while the women died mostly in the subacute stage after being admitted to the hospital. There were also significantly more female deaths arising from acute MI as compared to the men (Miric et al, 2009).

Study 7 focused on the type of medical care given to both male and female patients once they have reported to the hospital. The researchers focused on the patients receiving PCI and noted that females were less likely to get optimal health care than men. This was because some helpful drugs were given to most males but were not given to most females. The women also had more complications arising from the procedure as compared to the men.

This was also seen to contribute to the fact that the women were getting less optimal care as compared to the men (Jibran et al, 2010). Study 8 looked at literature from the field of psychology but with direct relation to myocardial infarction. Here, gender differences were also noted. It was established that women were at a higher risk of suffering from psychological impairment than men following myocardial infarction or other coronary incidences. This was consistent with similar studies on psychological impairment done on different groups, including healthy populations (Brezinka, Maes & Dusseldorp, 2009).

Integration of Major Findings

From all the literature reviewed in this paper, some significant points emerge. The studies were able to bring out some of the major differences in male and female patients suffering from myocardial infarction. The first point to take note of is that the average age of women presenting with MI is significantly higher than that of men (Ludblad et al, 2008). This was one fact that was consistent across all the literature that dealt with myocardial infarction. One of the main reasons given for this significant difference is estrogen. This hormone is known to have cardioprotective properties and may have contributed to delaying heart attacks in women (Jibran et al, 2010).

However, some conditions are known to override this protection from estrogen, leading to early cases of myocardial infarction in women. For example, diabetes is known to be a major contributor to coronary heart disease, heart failure, and stroke in younger women. This is because it eliminates the protective effect of estrogen. Apart from estrogen, many other female-specific conditions contribute to the gender differences in the pathophysiology of myocardial infarction. These include gestational diabetes, eclampsia and preeclampsia, early menopause, polycystic ovarian syndrome, and low-birth-weight children. Women generally have smaller and less compliant arteries than men, and this was given as one of the reasons why women were more prone to coronary artery disease.

Another major finding is the differences in the presentation of symptoms in both men and women. The most common symptom associated with myocardial infarction is chest pain. Many people take this as the classic sign of MI, and they expect to experience it when they are having a heart attack. In the literature reviewed in this paper, it is clear that this symptom is not common in women. About half of the women or less who suffered heart attack felt any chest pain. Those who did not suffer any chest pain did not realize at first that they were having a heart attack because they expected to have chest pain in case it happened.

Women also had a lot of atypical symptoms that cannot be readily associated with myocardial infarction (Zbierajewski-Eischeid & Loeb, 2010). Some of the symptoms like poor sleeping patterns, upper abdominal pain, back pains, nausea, and fatigue can be strongly associated with other conditions before myocardial infarction is considered. The women also had more cases of stuttering symptoms that only reinforced their beliefs that they were not suffering a heart attack. Since the symptoms came and disappeared now and then, they tended to wait for the symptoms to disappear after an attack rather than seek medical attention. The atypical presentation of symptoms in females caused many of them to delay in seeking treatment for myocardial infarction since they did not realize it in the first place.

The literature also reveals that more women died of acute MI as compared to the men (Miric et al, 2009). The atypical presentation of symptoms is a major contributor to this fact. In the event of a heart attack, treatment should come within one hour to give the patient a real chance of surviving and to avoid any complications that may arise. This is not possible if the patients, mostly women, do not realize that they are having a heart attack. The situation is made worse if the symptoms are stuttering since they will be largely ignored. Women are also known to sacrifice their well-being for the rest due to their caring nature.

They are therefore more likely to avoid asking for help from the people around them so as not to disturb them and instead hope that the symptoms will go away. There are also more in-hospital deaths among women with MI than their male counterparts. From the literature reviewed, it emerged that women with MI may be getting less optimal health care as compared to men with the same condition (Jibran et al, 2010). In most cases, the women were not given certain medications that are known to be very helpful in such situations yet the men in the same hospital were given those drugs. The reason for this was not given by the health care professionals but it could be an indication that the women patients are not being taken seriously. It was also clear that women suffered more complications associated with the treatment using the PCI procedures.

Most of these complications have to do with catheterization and the site of needle entry. Very few men had such complications. This could mean that the nurses are being very careful when handling the male patients, while there could be some complacency with the female patients. All these indicators of suboptimal care given to the women in the hospital may be the reason why there are significantly more female deaths in hospitals due to MI as compared to the men.

It also emerged from the literature reviewed that women have a significantly higher proportion of new cases as compared to recurrent cases, while in men the cases were fairly balanced. This could mean that most women eventually die after the first heart attack so few survivors will suffer recurrent attacks. It could also mean that after the first attack, the women recover well after treatment and can avoid any recurrent attacks. For the men, this could mean that they get very good medical care, so they can survive the first heart attack and the recurrent attacks as long as they get to the hospital in time. It could also mean that they do not follow the doctors’ instructions on how to take good care of themselves so that they avoid having recurrent attacks. Study 8 also deals with myocardial infarction but aims to show the gender differences as seen in the field of psychiatry.

There are several reasons why there are significantly more female patients with psychological impairment as compared to men. First of all, studies have consistently shown women to be at more risk of many psychological and psychiatric disorders as compared to men, and this could be another manifestation of the trend. It could be because women are under more stressful conditions at work and home. The emotional nature of the women could also be a contributing factor. They take things very personally and as such, they are likely to be hurt when things do not go their way. In addition, women are known to hide their feelings and will try to suffer silently, while the men usually express themselves and vent freely in case something bad happens to them.

The case of women bottling up emotions could contribute to them suffering more psychological impairment and other psychiatric disorders as compared to the men (Brezinka, Maes & Dusseldorp, 2009). By demonstrating the gender differences in psychological impairment of patients with myocardial infarction and other coronary incidences, this paper hopes to show that the gender differences cut across many fields, and there needs to be a comprehensive treatment and management plan that takes care of all aspects.

Implications of the Findings

From the information in all the literature reviewed in this paper, the implications are major. First, having established that there are differences in the presentation of symptoms of myocardial infarction between men and women, there is a need for a thorough review of all symptoms associated with MI. Such a review should pay special attention to the symptoms unique or frequent in women as compared to men. Since most people expect there to be chest pain during a heart attack, a sustained public campaign to enlighten the public about all the symptoms of myocardial infarction is necessary. There is also a need to review the diagnostic criteria to ensure that no symptoms are left out.

People should also be urged to seek medical help immediately if they are not feeling well. If the women know that the atypical symptoms could also be indicative of MI, they will be able to seek help faster and this can help reduce their mortality rates especially due to acute MI.

The difference in the presentation of myocardial infarction in men and women also calls for a review of the treatment regimens to better take care of the women (Zbierajewski-Eischeid & Loeb, 2010). Since men and women react to treatment differently, and with more women dying in hospital in the course of treatment, there is a need to find better ways of treating the women. There have been calls for gender-specific drugs to be used in the treatment of MI and other conditions. The literature also indicated that the women were receiving sub-optimal care as compared to the men. This should not be the case, and all the healthcare stakeholders should look into this issue and address the discrepancy. Female patients are entitled to the best medical care just like their male counterparts and this should form part of the policy for any healthcare institution (Jibran et al, 2010).

Women with symptoms of coronary disease get less referral for cardiovascular procedures than their male counterparts yet these procedures can help in the prevention or early detection of myocardial infarction and other heart conditions. Since more female patients suffer complications in the course of treatment, they need to be monitored more closely to avoid the complications from arising (Lundblad et al, 2008). The nurses can play a very significant role in this aspect since they are charged with taking care of patients once they are hospitalized. While in the hospital setting, the nurses should ensure that all procedures related to treatment are performed with utmost care and in the correct way. It is also important to get the right medication and to give it in the right doses at the right times. Having a myocardial infarction also has a significant psychological effect on the patients.

These patients ought to be screened for psychological cases at regular intervals as part of the overall treatment regimen. Such assessment should use gender-specific norms bearing in mind that women, even the healthy ones, tend to suffer more cases of psychological impairment (Brezinka, Maes & Dusseldorp, 2009). The healthcare providers should also stress the importance of taking good care of one’s health to the patients, both male and female. Since most cases of MI arise due to lifestyle choices, it is important to stress the need for a lifestyle change to avoid complications and recurrent cases. Most importantly, the public should be properly educated on all the symptoms, typical and atypical, of myocardial infarction and the importance of getting immediate help in case someone is having a heart attack.

Conclusion

This paper aimed to establish if there are gender differences in patients with myocardial infarction and to highlight those differences. From the literature reviewed here, it is clear that there are several significant differences in various aspects of the disease. First, there are differences in the average ages at which the patients present with MI for the two sexes, with the women being generally older.

One of the reasons for this is because estrogen offers women some form of protection thus enabling them to live longer before suffering a heart attack. There were also notable differences in the presentation of symptoms between the two sexes (Zbierajewski-Eischeid & Loeb, 2010). Only about half of the women experienced chest pain, which is considered the classic symptom of MI. The women also had other atypical symptoms not readily associated with MI, and this is part of the reason why they delayed significantly longer in seeking treatment as compared to the men. The delay in seeking treatment led to women suffering significantly more deaths as a result of acute MI than their male counterparts. The literature also revealed that women were more likely to die in hospital from MI as compared to men (Shiraki & Saito, 2011).

One of the reasons emerging from the study is because women generally get sub-optimal health care in hospitals as compared to men (Jibran et al, 2010). From all the literature reviewed here, it is clear that the approach to treatment and management of MI has to be changed, and the women’s concerns have to be addressed to ensure that they also get the best possible treatment for MI.

References

Banks, A.D., Dracup, K. (2007). Are There Gender Differences in the Reasons Why African Americans Delay In Seeking Medical Help for Symptoms of an Acute Myocardial Infarction? Ethnic Discussions, 17. Web.

Brezinka, V., Maes, S., Dusseldorp, E. (2009). Gender differences in psychological impairment after a coronary incident. Personality and Individual Differences, 30. Web.

Jibran, R., Khan, J.A and Hoye, A. (2010). Gender Disparity in Patients Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndromes. Annals Academy of Medicine Singapore, 39. Web.

Lundblad, D., Holmgren, L., Jansson, J.H., Naslund, U. and Eliasson, M. (2008). Gender differences in trends of acute myocardial infarction events. BMC Cardiovascular Disorders, 8(17). Web.

Mackay, M., Ratner, P.A., Johnson, J.L., Humphries, K.H. and Buller, C.E. (2012). Gender Differences in Symptoms of Myocardial Ischaemia. European Heart Journal, 32 (24). Web.

Miric, L., Miric, D., Duplancic, D., Kokic, S., Ljutic, D., Pesutic, V., Culic, V., Fabijanic, D., Titlic, M. (2009). Specific and gender differences between hospitalized and out-of-hospital mortality due to myocardial infarction. Medline. Web.

Shiraki, T., Saito, D. (2011). Sex Difference of In-hospital Mortality in Patients with Acute Myocardial Infarction. Acta Medica Okayama, 65(5). Web.

Zbierajewski-Eischeid, S. J., Loeb, S. J. (2010). Recognizing myocardial infarction in women. Nursing Spring, 40. Web.