Authors: Laoura Pari, Marinos Soteriou, Lambros Mitselos, Ekaterini Lambrinou.
Introduction: In Europe, Cardiovascular Diseases (CVDs) remains the most common cause of morbidity and mortality, with 49% of deaths in women and 40% of deaths in men. Women have a higher risk of CVDs mortality, worse prognosis, and outcomes, major cardiovascular events, are undertreated, and have a lower rate of diagnostic angiograms and interventional procedures, compared to men.
Case Summary: A 61-year-old white female, presented to the Emergency Department (ED) with chief complaints of sudden bone pain and a headache. She had been evaluated but discharged without further investigation from another ED, because of the symptoms she reported. She has a history of smoking for 30 years. Her family history included sudden death for both parents, with the symptomatology of an aneurysm. She never had a cardiovascular (CV) assessment before or any CV symptoms. Upon triage, the pain was located in the upper back and extended down the back. She characterized it as ‘bone pain’ (skeletal pain). Vital signs revealed high Blood Pressure (BP) [216/97] mmHg. Her initial laboratory investigation revealed D-dimers level 1.01μg/ml with an upper limit of normal <0.50μg/ml. Urgent Computerized Tomography Angiography of whole aorta with IV contrast was performed and a diagnosis of Aortic Dissection Stanford Type B was given. The patient was admitted to the ICU for close hemodynamic monitoring and medical therapy, BP control, and pain management. The patient was monitored for 19 days without any complications. There were no indications for surgical intervention between admission and discharge, based on the latest guidelines.
Discussion: The presented clinical case is an example of lack of adequate recognition and assessment by health professionals, but also of inadequate prevention and delay of presentation to medical care by the patient due to misconception. This must drive the community of cardiology to implement changes in prevention, diagnosis, intervention, and management for women, and provide education and training in early recognition and management of CVDs in the medical community, taking into consideration the sex and gender differences.
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