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Clinical features and diagnosis of coronary heart disease in women

Pamela S Douglas, MD
Neha Pagidipati, MD, MPH
Section Editors
Juan Carlos Kaski, DSc, MD, DM (Hons), FRCP, FESC, FACC, FAHA
Patricia A Pellikka, MD, FACC, FAHA, FASE
Deputy Editor
Gordon M Saperia, MD, FACC


There are significant differences between men and women in the epidemiology, diagnosis, treatment, and prognosis of coronary heart disease (CHD). These should be taken into account in the care of women with known or suspected disease.

The clinical features and diagnosis of CHD in women will be reviewed here. The management of CHD in women in general and specific information regarding young women are discussed separately. (See "Management of coronary heart disease in women" and "Coronary heart disease and myocardial infarction in young men and women".)


Cardiovascular disease, including coronary heart disease (CHD), is 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 CHD since 1980, it accounted for 22 percent of all-cause mortality in women in 2013 [3]. Between the ages of 45 to 64, one in nine women develop 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. Additional epidemiologic information and issues related to prognosis are found elsewhere. (See "Epidemiology of coronary heart disease".)


The initial presentation of coronary heart disease (CHD) in women and men is more often than not similar. It may be a stable pattern of chest pain (stable angina), an acute coronary syndrome, heart failure (HF), or sudden cardiac death (SCD). Rarely, there are no symptoms and the initial presentation is an abnormal cardiac test such as an electrocardiogram or echocardiogram ordered for another reason.

This section will discuss how female sex may lead to presentation and diagnosis that differs somewhat from those in men. The broad discussions of presentations and diagnosis of CHD are found elsewhere. (See "Stable ischemic heart disease: Overview of care", section on 'Clinical manifestations' and "Criteria for the diagnosis of acute myocardial infarction", section on 'Third universal definition of MI' and "Evaluation of the patient with suspected heart failure", section on 'Clinical presentation' and "Evaluation of the survivor of sudden cardiac arrest", section on 'Initial evaluation'.)

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Literature review current through: Nov 2017. | This topic last updated: Dec 07, 2017.
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