Identifying and managing chest pain in women
Heart disease continues to be the leading cause of death in women in the United States. Sex disparities remain despite research highlighting the unique aspects of managing women with ischemic heart disease. Increased mortality in women may be related to the critical differences in the clinical presentation of ischemic heart disease between the sexes. Sex-related differences in the pathophysiology of ischemic heart disease also influence diagnostic testing and management. This article reviews the differences in diagnosis and management between men and women with ischemic heart disease. Managing ischemic heart disease in women is challenging for clinicians in many settings, including primary care, emergency medicine, gynecology, and cardiology. Women have greater symptom burden, more adverse outcomes, increased functional disability, and higher healthcare costs compared with men with ischemic heart disease. Researchers are still uncertain about the fundamental mechanisms responsible for coronary ischemia in women. Clinicians who understand the differences in the pathophysiology, symptomatology, diagnostic testing, and treatment for ischemic heart disease in women can provide prompt, appropriate care for women with chest pain. This article reviews the epidemiology, pathophysiology, clinical presentation, diagnostic evaluation, risk stratification and modification and risk reduction of heart disease in women.