B. Delia Johnson

CAROTID ARTERY DISTENSIBILITY AND HORMONE THERAPY DURING MENOPAUSE: THE LOS ANGELES ATHEROSCLEROSIS STUDY (LAAS)

Cross-sectional studies suggest that arterial distensibility decreases during menopause; however, relation to hormone therapy (HT) is controversial. We prospectively studied distensibility and HT during menopause. 161 women aged 42 – 61 yr without cardiovascular disease had carotid artery

MICROVASCULAR CORONARY DYSFUNCTION, LEFT VENTRICULAR VOLUMES AND MASS: RESULTS FROM THE WOMEN'S ISCHEMIA SYNDROME EVALUATION-CORONARY VASCULAR DYSFUNCTION STUDY

Women with signs and symptoms of ischemia and no obstructive coronary artery disease (CAD) often have microvascular coronary dysfunction (MCD). This has been associated with adverse outcomes including hospitalization for heart failure with preserved ejection fraction (EF). We sought to explore how

State-of-the-Art Diagnostic Testing in Women

Despite advances in the diagnosis and management of cardiovascular disease (CVD), nearly 250,000 female lives are claimed each year (1). Research continues to report underrecognition, underdiagnosis, and undertreatment of coronary disease in women causative to higher CVD mortality (2–9). Nonspecific symptoms, such as generalized malaise, fatigue, and dyspnea in women are imprecise and ineffective discriminators of disease (10). Older age of presentation and delays in atypical symptom recognition contribute to a greater morbidity and mortality for the female patient (11). Screening of the asymptomatic woman is a topic of much interest because the initial presentation of sudden cardiac death occurs more frequently in women (63%) than in men (50%) (1).

Clinical Risk Assessment in Women

Chest pain is one of the most common complaints encountered by the emergency physician. Each year, 5.3 million patients appear at US emergency rooms with chest pain (1). More than half of these patients are women (2). The chief clinical concern in evaluation is the possibility of acute coronary syndrome (ACS) and the need to provide quick and appropriate therapy to reduce the risk of death and serious complications (3). Often, coronary angiography and other objective testing is performed only after clinical history, including chest pain evaluation, reveals a reasonable likelihood that a patient might suffer from ACS. For women, such a likelihood is more difficult to assess than in men. This chapter addresses the issues in using chest pain assessment as part of a coronary artery disease (CAD) diagnostic work-up in women. The first part summarizes the available literature. In the second part, the widely used Coronary Artery Surgery Study (CASS) symptom classification is tested in a pilot group of Women’s Ischemia Syndrome Evaluation (WISE) study participants to provide preliminary evidence toward the development of a female pattern angina classification.