Evaluation and management of chest pain from cardiovascular causes in female patients

Chest pain is a common presenting complaint in clinical practice and a leading cause of emergency department visits. However, the assessment and management of cardiac causes of chest pain in female patients present unique challenges owing to sex related differences in symptom presentation, underlying pathophysiology, and risk factors. Female patients are often underdiagnosed and undertreated, contributing to poorer cardiovascular outcomes. This review explores the current approaches to acute and stable chest pain in female patients while highlighting sex specific considerations in diagnosis, treatment, and differentials. Given the scope of this topic, the review focuses largely on cardiovascular causes of chest pain. In the evaluation of female patients with chest pain, understanding the differences in presentation, interpretation of common diagnostic tests, and evidence behind treatment is important. As female patients are more likely than male patients to have a diagnosis of myocardial infarction with non-obstructive coronary arteries, spontaneous coronary artery disease, and Takotsubo syndrome, understanding the unique features of these diagnoses is also important. In addition, valvular disease has unique features in female patients. Other factors such as age, polycystic ovary syndrome, and pregnancy increase female patients' cardiovascular risk, yet little evidence is available on the optimal investigation and management of cardiac chest pain in these special populations. Focusing on the evaluation of female patients, the existing literature on the management of acute and stable chest pain is reviewed.