II. Pathophysiology: Contributing factors specific to women

  1. Premature Coronary Artery Disease affects women to greater extent than men
  2. Obstetric cardiovascular complications
    1. Preeclampsia
    2. Gestational Diabetes
  3. Hormonally-related issues
    1. Hyperandrogenic states such as Polycystic Ovary Syndrome
    2. Hormone Replacement Therapy
    3. Surgical Menopause or other hypoestrogenemia cause
  4. Vascular conditions more common in women
    1. Vasculitis (esp. Collagen vascular disease)
    2. Stress Cardiomyopathy (transient myocardial syndrome with extreme stress)
    3. Coronary or aortic root dissection

III. Symptoms: Atypical or vague compared with men (present to ERs 2 hours after men)

  1. Chest Pain
  2. Back, neck, Shoulder, or Abdominal Pain
  3. Shortness of Breath
  4. Nausea or Vomiting
  5. Cold sweats
  6. Fatigue
  7. Weakness
  8. Anxiety
  9. Anorexia

IV. Evaluation

  1. Framingham Score and NCEP III guidelines underestimate risk in women
    1. Does not account for Obesity, inactivity, Hypertriglyceridemia, Family History
  2. Reduced non-invasive stress Test Sensitivity in women
    1. Women often have single vessel disease
    2. Women more often fail to reach a maximal stress test (>5 Mets are required)
    3. ST depression and Chest Pain with Exercise are not good predictors in women

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