Angina in Women

Abstract

Angina pectoris, the pain of myocardial ischemia, is the major initial and subsequent presentation of coronary disease in women. Angina in women is associated with more adverse morbidity, mortality, and quality-of-life outcomes than for men, despite women having less obstructive coronary artery disease and better left ventricular function. Women with chest pain and myocardial ischemia, in the absence of significant obstructive disease of the coronary arteries, have prominent morbidity and mortality outcomes; the postulated mechanism is microvascular disease. Women also have more non-chest pain manifestations of myocardial ischemia than men. These variables must be incorporated in assessments of optimal diagnostic and therapeutic strategies for myocardial ischemia in women.

Acute Myocardial Infarction in Women

“…[184][185][186] Although most patients with AMI present with typical chest pain or chest discomfort, women often present with atypical chest pain and anginaequivalent symptoms such as dyspnea, weakness, fatigue, and indigestion, as illustrated in Table 1. 187 Sex differences in clinical presentation have consequences for timely identification of ischemic symptoms, appropriate triage, and judicious diagnostic testing and management. The detrimental consequences for women are misdiagnosis, delayed revascularization, and higher AMI mortality rates.…”

Cardiovascular epidemiology of postinfarction angina and menopause age

“…We now understand the extensive contrast between how men and women experience acute coronary syndromes. 2 We also understand, contrary to Dr. Heberden's observations, that the prevalence of Americans who have coronary diseaseV estimated to range from 6.5 million to 16.5 millionVis comparable between the sexes. 3 Age at menopause has been well established as a unique risk factor for cardiovascular disease in women.…”

“…Follow-up data included medications, lifestyle, subsequent evaluation, risk factor management, and, importantly, a well-validated questionnaire, the Seattle Angina Questionnaire (SAQ), to measure anginal symptoms. The SAQ is a set of five scales addressing (1) the stability of angina symptoms over time, (2) angina frequency, (3) physical limitation, (4) treatment satisfaction, and (5) quality of life. 6 The components of the SAQ have been associated with all-cause mortality in prior studies.…”

“…22 It has been suggested that these pathways lead to coronary small vessel vasculopathy in postmenopausal women, often without coexisting flow-limiting obstructive coronary artery disease. 2,23 We perceive the work of Parashar et al as an important step forward. Women remain understudied in cardiovascular disease.…”

Stemi in women

“…Although most patients with AMI present with typical chest pain or chest discomfort, women often present with atypical chest pain and angina equivalent symptoms such as dyspnea, weakness, fatigue, and indigestion [20]. Compared with men, women are more likely to have high risk presentations and less likely to manifest central chest pain [21,22].…”