[Symptoms and diagnosis of coronary heart disease in women]
Sigrun Halvorsen1, Cecilie Risøe
1Hjertemedisinsk avdeling, Oslo universitetssykehus, Ullevål 0407 Oslo, Norway. sigrun.halvorsen@ulleval.no
Insights
Coronary heart disease (CHD) presents differently in women, often with less specific symptoms and less accurate diagnostic tests compared to men. New diagnostic techniques are needed for effective risk stratification and treatment.
Area of Science:
- Cardiology
- Women's Health
- Diagnostic Imaging
Background:
- Coronary heart disease (CHD) in women exhibits distinct characteristics compared to men, affecting symptoms, clinical presentation, diagnostic test accuracy, and treatment response.
- Understanding these differences is crucial for accurate diagnosis and effective management of cardiovascular disease in female patients.
Purpose of the Study:
- To review the specific symptoms and diagnostic challenges of coronary heart disease in women.
- To discuss currently available diagnostic procedures and their limitations in the female population.
Main Methods:
- A non-systematic literature search of PubMed was conducted to identify relevant studies.
- The review synthesizes findings on the presentation and diagnosis of coronary heart disease in women.
Main Results:
- Myocardial infarction typically occurs later in women but risk factors can negate this advantage.
- Women with CHD are less likely to present with chest pain and may have atypical symptoms, complicating diagnosis.
- Traditional diagnostic tests show lower accuracy in women, and coronary angiography reveals more diffuse atherosclerosis, posing diagnostic challenges. Coronary CT angiography shows promise but requires further study regarding accuracy and radiation dose in women.
Conclusions:
- A recommended strategy involves risk stratification followed by identification of patients requiring invasive testing.
- There is a significant need for the development of novel diagnostic techniques tailored to identify coronary heart disease accurately in women.
Background:
Coronary heart disease in women is different from that in men with respect to symptoms, clinical presentation, value of the diagnostic tests and response to treatment. The article presents a review of symptoms and diagnostics of coronary heart disease in women and discusses the diagnostic procedures that are available.
Material And Methods:
The review is based on literature identified through a non-systematic search of PubMed.
Results:
In general, myocardial infarction hits women about ten years later than men, but women with risk factors loose their sex advantage. Women with coronary disease are less likely to experience chest pain than men and may have less specific symptoms. Traditional non-invasive diagnostic investigations are less accurate than in men. Women with angina or myocardial infarction also have a lower prevalence of significant stenoses in coronary angiography, and atherosclerosis seems to be more diffuse than in men. This renders the diagnostic approach more difficult. Coronary CT angiography is a promising diagnostic technique, but few women have been included in studies of the method's accuracy, and the radiation dose is still relatively high.
Interpretation:
We recommend a strategy that emphasizes risk stratification of patients, and thereafter identification of patients in need of further invasive testing. New techniques are needed to identify coronary heart disease in women.
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