II. Pathophysiology: Contributing factors specific to women
- Premature Coronary Artery Disease affects women to greater extent than men
- Obstetric cardiovascular complications
- Hormonally-related issues
- Hyperandrogenic states such as Polycystic Ovary Syndrome
- Hormone Replacement Therapy
- Surgical Menopause or other hypoestrogenemia cause
- Vascular conditions more common in women
- Vasculitis (esp. Collagen vascular disease)
- Stress Cardiomyopathy (transient myocardial syndrome with extreme stress)
- Coronary or aortic root dissection
III. Symptoms: Atypical or vague compared with men (present to ERs 2 hours after men)
- Chest Pain
- Back, neck, Shoulder, or Abdominal Pain
- Shortness of Breath
- Nausea or Vomiting
- Cold sweats
- Fatigue
- Weakness
- Anxiety
- Anorexia
IV. Evaluation
-
Framingham Score and NCEP III guidelines underestimate risk in women
- Does not account for Obesity, inactivity, Hypertriglyceridemia, Family History
- Reduced non-invasive stress Test Sensitivity in women
- Women often have single vessel disease
- Women more often fail to reach a maximal stress test (>5 Mets are required)
- ST depression and Chest Pain with Exercise are not good predictors in women
