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[learn_more caption=”By Dr. Harold Dion”]
Dr. Harold DionHarold Christian Dion studied medicine at the University of Ottawa and Family Medicine at McGill University.

He has worked at the Clinique médicale l’Actuel in Montreal for the past 25 years.
He is also co-editor-in-chief of “e-Relais VIH”, a Canadian bilingual online publication for patients living with HIV.

Over the past 10 years, Dr. Dion has published several articles on various health issues, for both general public (Coup de pouce, 7 Jours, Reader’s Digest) and healthcare professionals (L’actualité médicale, Le Clinicien, l’Omnipraticien, MedActuel FMC, Le Médecin du Québec).

More and more studies are now revealing that the symptoms of disease can be gender-specific. For example, researchers at the University of Michigan and Vanderbilt University (involving 5,700 adults, 41% of whom were men) have shown that depression affects men just as much as women, but their symptoms can be different. While women tend to experience the common symptoms used to diagnose depression, such as sadness, guilt, worthlessness, reduced interest in once enjoyable activities and insomnia, men tend instead to express aggression, irritability, anger, hyperactivity, risk taking and substance abuse. This study is significant in that women are currently twice as likely to be diagnosed with depression and these results suggest that relying on men’s disclosure of traditional symptoms could lead to an under diagnosis of depression in men.

Another example is provided by a study that was conducted at the University of Montreal and published in the January 2014 issue of the journal “Sleep”. The researchers analyzed 253 nightmares and 431 bad dreams obtained from the dream journal that was kept by 572 participants over a period of two to five weeks (providing approximately 10,000 dreams). What they found was that men tend to dream about disasters such earthquakes, floods and wars, while women dream twice more often about interpersonal conflicts.

Finally, a group of Canadian researchers recently published in JAMA, the results of a prospective cohort including over 1,000 patients admitted to the hospital over a three to four year period with acute coronary syndrome, at 24 centers across Canada (one also in the US and one other in Switzerland), which demonstrated that 20% of women under the age of 55, do not experience chest pain in that situation. Women were more likely to experience nausea, shortness of breath, sweating and sudden extreme fatigue. In addition, the absence of chest pain did not signify that the heart attack was less severe. The troponin levels and the percentage of coronary stenosis, which are indicative of the severity of the infarction, did not differ in the patients of this cohort.

These results show once again that we must be wary of preconceived ideas : myocardial infarction does not only occur in middle aged men who arrive in the emergency department gripping at their chest. We must therefore be able to recognize the early signs and adapt to a new standard of evaluation for young women. It is also very important to remember that chest pain is not the only indicator of an acute coronary syndrome. Otherwise, myocardial infarctions will be under diagnosed, treatment will not be undertaken rapidly and the risk of death will be greater, as we know now, that time is an extremely important factor in the treatment of this condition.

This has not been extensively studied in HIV+ patients, but it would be wise to consider this data, as those symptoms are frequently encountered in this population.