Written by Ketan Patel
Spoon Feed
Despite being well documented, females with chest pain continue to suffer from misdiagnosis and later presentation, receive fewer guideline-directed therapies and invasive procedures, and have worse short- and long-term cardiovascular outcomes compared to males.
High stakes: sex-specific pitfalls in women with chest pain
This review synthesizes new data to build on long-recognized sex disparities in acute coronary syndrome (ACS). The data unfortunately show persistence of treatment gaps in women, as a one-size-fits-all approach has done little to improve cardiovascular care for the female patient.
This narrative review asks how cardiovascular causes of chest pain in female patients differ in presentation, diagnosis, and management. Using a structured PubMed search (2020–2025) of clinical trials, systematic reviews, and guidelines, it reports that women account for ~30% of myocardial infarctions and up to 57% of ED ACS visits, have more MIs with non-obstructive coronary artery disease (6–8% of MI; ~43% female), spontaneous coronary artery dissections (80–90% female), higher bleeding with dual antiplatelet therapy or anticoagulation, lower hs‑troponin 99th centiles (16 vs. 34 ng/L), and persistent delayed, less aggressive care.
As this is a narrative, guideline-oriented review of heterogeneous secondary data with low female enrollment, conclusions are vulnerable to selection and publication bias, which may limit generalizability across all populations and ED settings.
How does this change my practice?
It is hard to summarize all the disparities impacting females in this brief post. This article is worth a full read to better grasp these nuances and persistent care gaps. I will be referencing it for my learners, to hopefully limit bias and break the one-size-fits-all approach to chest pain.
Source
Evaluation and management of chest pain from cardiovascular causes in female patients. BMJ (Clinical research ed.). 2026;392:e086177. PMID: 41617253
