Journal of the College of Physicians and Surgeons Pakistan 2012, Vol. 22 (5): 285-288 285 INTRODUCTION Acute coronary syndrome (ACS) is one of the leading causes of hospital admissions. Mostly patients present with complaints of chest pain. Various parameters and characteristics of pain differentiate ACS pain from other differential diagnosis of chest pain. At the same time unstable angina, Non ST elevation myocardial infarction (NSTEMI) and ST elevation myocardial infarction (STEMI) may also present differently with respect to various parameters of pain. Gender differences in the presentation and management of ACS are well established internationally. 1,2 Aim of this study was to determine whether there are gender based difference of various parameters of pain and associated symptoms in patients presenting with ACS in the local population. METHODOLOGY This study was conducted at National Institute of Cardiovascular Diseases, Karachi, Pakistan. Adult patients admitted in medical wards with diagnosis of ACS, from January to June 2010, were included in the study. Information on personal biodata, site of pain, characteristics of pain, severity of pain, duration of pain, course of pain and associated symptoms was obtained by questionnaire. The choices of items included in the questionnaire were guided by previous clinical trials and personal experience of local conditions. Patients were excluded who were having another serious comorbidity such as severe renal failure, severe chronic obstructive pulmonary disease, and advanced malignancy. Unstable angina was diagnosed in patients who presented with anginal pain, but two samples of their Troponin I after 6 and 12 hours of onset of pain were negative. Non-ST elevation myocardial infarction (NSTEMI) was diagnosis in patients whose Troponin I was positive along with anginal pain. ST elevation myocardial infarction (STEMI) was diagnosis in patients whose ECG showed 1 mm elevation in two consecutive leads along with anginal pain. Anginal pain was defined as chest pain anywhere from chest to umbilicus. Pain which occurred without pain free interval was defined as continuous pain. While pain with some pain-free interval was labelled as intermittent pain. Mean ± standard deviation was calculated for age of the patients. Fisher's exact test and Chi-square analysis were used for qualitative data. A p < 0.05 was considered statistically significant. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 15.0 for Windows. ORIGINAL ARTICLE Gender Based Differences in Symptoms of Acute Coronary Syndrome Sayed Fayaz Mujtaba 1 , S. Nadeem H. Rizvi 1 , Anosha Talpur 2 , Fazla Younis 2 , Kiran Minhas 2 and Zoya Farooqui 2 ABSTRACT Objective: To determine gender based differences in presenting symptoms in patients with acute coronary syndrome. Study Design: Cross-sectional, comparative study. Place and Duration of Study: National institute of Cardiovascular Diseases (NICVD), Karachi, from January to June 2010. Methodology: Information was obtained by questionnaire from the patients who fulfilled the inclusion criteria. Fisher's exact test and Chi-square analysis were used for data testing. A p < 0.05 was considered statistically significant. Results: Four hundred and thirty-seven patients included 230 males and 207 females. Among them unstable angina was diagnosed in 112 males and 142 females, Non ST elevation myocardial infarction (NSTEMI) was diagnosed in 37 males and 26 females. ST elevation myocardial infarction (STEMI) was diagnosed in 81 males and 39 females. Retrosternal pain was the presenting feature in 95 males and 100 females, left sided chest pain was noted in 155 males and 127 females, left arm pain was noted in 61 males and 59 females, right chest pain was noted in 74 males and 41 females, lower jaw pain was noted in 11 males and 16 females, abdominal pain was noted in 9 males and 17 females, 76 males and 88 females had dyspnea, 26 males and 38 females had vomiting, 24 males and 26 females had vertigo, 39 males and 28 females complained of sweating, 3 males and 6 females complained of palpitation, 2 males and 1 female complained of loss of consciousness. Conclusion: There are gender differences in the symptoms of ACS. These differences may have a bearing on clinical practice, interpretation of available clinical studies and the design of future investigations. Key words: Acute coronary syndrome. Gender based differences. Unstable angina. Chest pain. 1 North Ward, National Institute of Cardiovascular Diseases, Karachi. 2 Student, Dow University of Health and Medical Sciences, Karachi. Correspondence: Dr. Sayed Fayaz Mujtaba, North Ward, National Institute of Cardiovascular Diseases (NICVD), Karachi. E-mail: fayazmujtaba@yahoo.com Received February 19, 2011; accepted March 09, 2012.