Chest pain in women; special considerations.
(see Ginsberg, 1996; Manson, 2002)
- Women commonly present at a later stage of disease than men
- Women estimate their own likelihood of having coronary heart disease (CHD) to be extremely low. They are wrong.
- Physicians are less willing to diagnose atherosclerosis in younger women
- New data allows an accurate assessment of risk of CHD; patients unlikely to have CHD may be spared needless testing and unnecessary medication.
- Atypical/nonischemic pain is more common in women than in men.
- ECG is more likely to show 'non specific changes'; exercise test is less sensitive and specific.
- Disease tends to be more diffuse ; surgery and angioplasty are helpful, but in a smaller proportion.
- Significant risk factors for CHD are:
- post-menopausal status (lessened by hormone replacement therapy) ;
- diabetes mellitus.
- peripheral vascular disease ;
- hypertension ;
- smoking (relative risk of 2.4 with only 1-4 cigarettes/day)
- Low level HDL cholesterol is a better predictor than high level of LDL cholesterol - unlike the case in men.
- minor determinants include: age >65; obesity; sedentary lifestyle; family history of CHD.
Prevention of cardiovascular events in women : (Manson et al, 2002)
Moderate intensity exercise (brisk walking for at least 30 minutes daily on most days of the week) is associated with a risk reduction of approximately 30 % in post menopausal women.
Suggested Initial Diagnostic Tests in Women :- - Patients with lowest likelihood of CHD: - avoid testing.
- Patients with moderate likelihood of CHD:
- routine exercise tolerance test (ETT)
- if positive: imaging test ± catheterization.
- Patients with high likelihood of CHD:
- routine ETT.
- if negative: observe patient carefully ;
- if inconclusive/positive: catheterization.
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