Clinical features and diagnosis of coronary heart disease in women
- Pamela S Douglas, MD
Pamela S Douglas, MD
- Ursula Geller Professor of Research in Cardiovascular Diseases
- Duke University Medical Center
- Section Editors
- Juan Carlos Kaski, DSc, MD, DM (Hons), FRCP, FESC, FACC, FAHA
Juan Carlos Kaski, DSc, MD, DM (Hons), FRCP, FESC, FACC, FAHA
- Section Editor — Coronary Heart Disease
- Professor of Cardiovascular Science
- Director, Cardiovascular and Cell Sciences Research Institute
- St. George's, University of London
- Patricia A Pellikka, MD, FACC, FAHA, FASE
Patricia A Pellikka, MD, FACC, FAHA, FASE
- Section Editor — Noninvasive Cardiac Imaging and Stress Testing
- Professor of Medicine
- Mayo Clinic College of Medicine
Cardiovascular diseases are the most common cause of death and disability in women in the United States [1,2]. Although there has been a reduction in the death rate from coronary heart disease (CHD) since 1980 , CHD accounted for 35 percent of all-cause mortality in women in 1995  and 23 percent in 2004 . Between the ages of 45 to 64, one in nine women develops symptoms of some form of cardiovascular disease. After age 65, the ratio climbs to one in three women, according to the National Center for Health Statistics .
There are significant differences between men and women in the epidemiology, diagnosis, treatment, and prognosis of CHD that should be taken into account in the care of women with known or suspected disease. Furthermore, most available data suggest that women are not referred as often as men for appropriate diagnostic and/or therapeutic procedures, despite similar clinical conditions [6-12]. (See 'Diagnostic testing for suspected CHD' below.)
The clinical features and diagnosis of CHD in women will be reviewed here. The epidemiology and prognosis of CHD, management of CHD in women, and the problem of CHD in young women are discussed separately. (See "Epidemiology of coronary heart disease" and "Management of coronary heart disease in women" and "Coronary heart disease and myocardial infarction in young men and women".)
Women with coronary heart disease (CHD) are generally about 10 years older than men at the time of presentation and carry a greater burden of risk factors [13-15]. Women may not identify their initial symptoms as an expression of heart disease and therefore may not seek medical advice promptly and practitioners may not evaluate symptoms that represent myocardial ischemia as early in women [4,16]. (See "Overview of cardiovascular risk factors in women".)
Although women are generally older than men at presentation, women younger than age 45 years also develop CHD  and have a worse prognosis than men . The first presentation of CHD may be chest pain, myocardial infarction (MI), heart failure (HF), or sudden cardiac death (SCD). (See "Coronary heart disease and myocardial infarction in young men and women".)
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- CLINICAL PRESENTATION
- Chest pain
- Heart failure
- Sudden cardiac death
- DIAGNOSTIC TESTING FOR SUSPECTED CHD
- Noninvasive testing
- - For episodic chest pain
- - After non-ST elevation ACS
- - After ST-elevation MI
- Coronary angiography
- - Gender bias
- NON-CHD CAUSES OF CHEST PAIN
- Cardiac syndrome X or coronary microvascular disease
- Stress-induced cardiomyopathy
- Spontaneous coronary artery dissection
- INFORMATION FOR PATIENTS