Chest Pain in Women: Evaluation and Management

Despite the significant burden of ischemic heart disease (IHD) in women, the optimal evaluation and management of chest pain in this population is unclear, complicated by gender differences in presentation, etiology and disease perception as well as a relative paucity of specific, well-powered studies in this field. In contrast to male IHD, which is typically characterized by classical symptomology and demonstrable obstruction on angiography, chest pain in women is often more vague and more likely caused by an atypical etiology such as microvascular disease or endothelial dysfunction. The absence of macroscopic coronary obstruction presents a management challenge to physicians, and a large proportion of index cardiac events in women result in fatality. Evaluating chest pain is further complicated by gender discrepancies in the accuracy of diagnostic testing due to anatomical and physical variation. Furthermore, there is a distinct lack of awareness of disease severity among women and treating physicians, placing the imperative on the need for improving public education. This chapter will analyze current controversies pertaining to the evaluation and management of chest pain in women.