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Advanced Imaging and Diagnostic Methods in the Assessment of Suspected Ischemic Heart Disease in Women

  • Management of Acute Coronary Syndromes (AS Jaffe, Section Editor)
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Abstract

Although differences diminish with age, outcomes are overall worse for women compared to men who present with suspected acute coronary syndrome. The reasons for this discrepancy are multifactorial, including sex-related differences in atherosclerosis biology and fluid dynamics, as well as a premature conclusion by providers that chest pain must be noncardiac in the absence of obstructive coronary artery disease. In this review of existing literature, we explore the diverse differential diagnosis in this unique set of patients. Especially in women with persistent symptoms, absence of occlusive disease should prompt consideration for subangiographic plaque disruption, epicardial or microvascular endothelial dysfunction, transient neurohormonal imbalance predisposing to Takotsubo cardiomyopathy or spontaneous coronary artery dissection, underlying systemic inflammatory conditions, thromboembolic disease, myocarditis, and sequelae of congenital heart disease. As always, a thorough history and attentive physical exam will help guide further work-up, which in many cases may warrant noninvasive imaging, such as contrast-enhanced echocardiography, cardiac magnetic resonance imaging, or positron emission tomography, with their respective means of measuring myocardial perfusion and myocardial tissue pathology. Lastly, intracoronary imaging such as intravascular ultrasound and optical coherence tomography and invasive diagnostic methods such as coronary reactivity testing continue to add to our understanding that what appear to be atypical presentations of ischemic heart disease in women may in fact be typical presentations of pathologic cousin entities that remain incompletely defined.

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Authors and Affiliations

  1. Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, 701 19th Street South, LHRB 310, Birmingham, AL, 35294, USA

    Joanna M. Joly & Vera Bittner

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  1. Joanna M. Joly
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  2. Vera Bittner
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Correspondence to Vera Bittner.

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Joanna M. Joly and Vera Bittner declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Management of Acute Coronary Syndromes

Glossary of Terms

ACS

Acute coronary syndrome

CABG

Coronary artery bypass grafting

CCTA

Coronary computed tomography angiography

CFR

Coronary flow reserve

CFVR

Coronary flow velocity reserve

CMD

Coronary microvascular dysfunction

CMR

Cardiac magnetic resonance

CRT

Coronary reactivity testing

CSX

Cardiac syndrome X

IVUS

Intravascular ultrasound

Lp(a)

Lipoprotein(a)

MI

Myocardial infarction

MPI

Myocardial perfusion imaging

MPRI

Myocardial perfusion reserve index

NSTEMI

Non-ST elevation myocardial infarction

OCT

Optical coherence tomography

PCI

Percutaneous coronary intervention

PET

Positron emission tomography

QCA

Quantitative coronary analysis

RA

Rheumatoid arthritis

RHI

Reactive hyperemia index

SCAD

Spontaneous coronary artery dissection

SLE

Systemic lupus erythematosus

SPECT

Single-photon emission computed tomography

SS

Systemic sclerosis

STEMI

ST elevation myocardial infarction

UA

Unstable angina

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Joly, J.M., Bittner, V. Advanced Imaging and Diagnostic Methods in the Assessment of Suspected Ischemic Heart Disease in Women. Curr Cardiol Rep 18, 84 (2016). https://doi.org/10.1007/s11886-016-0767-0

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