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Dr K K Aggarwal

Younger women with acute coronary syndromes may not have classic chest pain

By Dr K K Aggarwal
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Younger women with an acute coronary syndrome are slightly less likely than men to present with the classic symptom of chest pain, according to a study published in JAMA Internal Medicine. As a result, they often fail to receive a correct diagnosis in the emergency department.

Nadia Khan and colleagues prospectively analyzed data from more than 1,000 ACS patients 55 years of age or younger– 30% of whom were women– participating in the GENESIS PRAXY study.

In these younger patients women were less likely to have chest pain than men (19% of women versus 13.7% for men, p = 0.03).

Women were also more likely than men to have a non-ST-segment elevation myocardial infarction (37.5% vs 30.7%; p = 0.03).

Upon multivariate analysis, women and patients with tachycardia were less likely to have chest pain. The absence of chest pain did not herald any change in the type or severity of the ACS.

Diagnosis of any disease with a lower prevalence but higher mortality, such as coronary artery disease in younger women, is more challenging.

Public health messages should “target both men and women regarding ACS symptom presentation with or without chest pain so as to encourage earlier and more widespread access to appropriate and lifesaving care.

During Sawan, air both in the body as well as in the atmosphere gets vitiated leading to storm of rains, high tides in the ocean and movement related disorders in the body. Ayurveda describes them as vata disorders and homeopathy describes them as Psora disorders. In allopathy, in terms of physical health, it represents dyspepsia, gases, distension, constipation, tachycardia, accelerated hypertension etc. and in terms of mind, it represents instability of mind, irritableness, anger and unsteady mind. This is one reason why in Sawan, auspicious functions are not held, including marriage as a marriage requires lot of cooperation, mental understanding and a steady mind. The mind is more unstable during Sawan is also depicted by the festival Guru Purnima which also falls in Sawan month. It indicates that during Sawan, one requires supervision to tame the mind. The Nag panchami also falls around this season. Nag is a symbolic representation of ego and Nag puja indicates again taming the mind and controlling the ego. Leafy vegetables are not allowed to be eaten during this month as they precipitate Airy disorders. It is also during this month that leafy vegetables contain more worms and their eggs and are unhygienic to eat especially in a community food serving. Sawan is also the month where on every Monday Lord Shiva is worshipped. Lord Shiva represents ability to wind up jobs. The unstable mind in Sawan month does not allow one to take decisive actions. Shiv ki pooja represents that it takes efforts to wind up jobs in Sawan month. During Sawan month, Lord Vishnu is also seen lying under a Sheshnag in an ocean in an open eye meditative pose. The ocean represents the disturbed state of mind, Sheshnag indicates the need to control the ego and meditative pose of Vishnu represents the need to do pranayama and meditation in this season and also it indicates that it is very easy to get dissociated from your consciousness in this month as the ego gets easily activated during this period.