[Gender perspective in the care experience and in the results of patients who consult for chest pain in an emergency department]

Objective

Clinical practice guidelines suggest performing an electrocardiogram (EKG) in patients with chest pain within the first 10 minutes in the emergency department, warning about subdiagnosis in women. Possible differences based on sex were analyzed.

Method

An observational and retrospective study in an Emergency Department, with adult patients admitted to the Chest Pain Unit in 2021.

Results

There were 1,469 patients, of whom 774 were men (52.7%). The men were younger (60 vs. 65 years), were less overweight (17.18 vs. 22.16%), and had more previous admissions to the Coronary Unit (12 vs. 7%), compared to women. No gender differences were observed in EKG performance (91 vs. 90%), EKG time (median 4.1 vs. 4.5 minutes), or delay in care attention (median 25 vs. 26 minutes). In terms of healthcare resources, men underwent more biomarkers: troponins (63 vs. 55%; odds ratio [OR]: 1.35; 95% confidence interval [95%CI]: 1.10-1.67) and creatine phosphokinase (24.8 vs. 19.1%), received more aspirin (6.7 vs. 3.1%), nitrates/nitrites (6 vs. 3%), and hospitalization (17.18 vs. 10.50%; OR: 1.76; 95%CI; 1.30-2.40). Of 206 hospitalized, 112 had a final diagnosis of acute coronary syndrome (54%), more men than women (81 vs. 31). There were no significant differences in revascularization time, medication schedule at discharge, hospital stay, or mortality.

Conclusions

Gender did not affect precordial pain care, diagnosis, and treatment times, highlighting the quality of hospital care.

Kidney-lung pathophysiological crosstalk: its characteristics and importance

Crosstalk between the lung and the kidney is based on the similarities that these organs share. This is why different diseases that affect one organ can have repercussions on the other. Patients with acute kidney injury can present complications such as pulmonary edema and require mechanical ventilation in respiratory failure. This interaction occurs due to the increase in systemic immune mediators that cause inflammatory reactions, oxidative stress, and an increase in vascular permeability in the lung. With regard to lung-induced renal damage, the kidney can also be affected by chemical mediators, which are translocated into the bloodstream. Moreover, the kidneys are extremely sensitive to oxygen changes which can cause them to lose their autoregulation mechanism. In patients with acute lung injury (ALI), oxygen supply is decreased causing renal hypoxia. Besides, hypercapnia generated by ALI causes vasoconstriction in the renal vascular network and activation of the renal angiotensin aldosterone system. ALI not only can cause renal injury, but also worsening chronic obstructive pulmonary disease and obstructive sleep apnea. In conclusion, kidney-lung crosstalk is commonly present in certain pathological states, and knowing its characteristics is crucial for managing the complications which may arise from this vicious circle.