Coronary Artery Disease in Female Athletes

Figures

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  Figure 1. Angiography Findings for Case 1 (A) Coronary CT angiography demonstrating a hypoplastic left main artery with critical (95%) noncalcified ostial stenosis of the LAD, which exhibits a sharply angulated course. (B) Invasive coronary angiography showing (left) a hypoplastic left main artery, (middle) a sharply angulated LAD with severe ostial stenosis, and (right) collateral flow from the right coronary artery to the first diagonal branch. CT = computed tomography; LAD = left anterior descending artery.

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  Figure 2. ECG and Angiography Findings for Case 2 (A) ECG obtained upon arrival at the emergency room displaying sinus rhythm with minimal ST-segment elevation in the inferior leads II, III, and AVF, without any reciprocal changes. (B) Urgent coronary angiography demonstrating a severe (90%) stenosis of the proximal LAD involving the diagonal bifurcation. ECG = electrocardiogram; LAD = left anterior descending artery.

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  Figure 3. ECG Findings for Case 3 (A) First ambulatory ECG showing sinus rhythm, QS complex in AVL, V1-V2, and T-wave inversions in AVL and leads V1-V3. (B) Second ECG showing persistent QS complexes in AVL and V1-V2, with T-wave inversions extending from AVL to V1-V6, in the context of continuous worsening chest pain. ECG = electrocardiogram.

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  Figure 4. Proposed Diagnostic Algorithm for the Evaluation of Suspected CAD in Female Athletes This flowchart outlines 4 key steps designed to improve the detection of CAD in female athletes. ∗Cardiovascular risk factors: diabetes mellitus, hyperlipidemia, hypertension, family history of ischemic heart disease, smoking, obesity. Women-specific risk factors, 1) pregnancy and reproductive health–related: adverse pregnancy outcomes, premature menopause (<40 years); 2) gynecological and hormonal conditions: polycystic ovarian syndrome; 3) other: autoimmune disease, depression. ∗∗Baseline ECG suggested for all female athletes >35 years according to 2020 European Society of Cardiology guidelines on sports cardiology and exercise in patients with cardiovascular disease.9,10#Functional testing should encompass a symptom-limited exercise test modified for athletes. CAD = coronary artery disease; CCTA = cardiac computed tomography angiography; ECG = electrocardiogram; TTE = transthoracic echocardiography.

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  Figure 5. Text Algorithm: 4-Step Process for Diagnosing CAD in Female Athletes, Focusing on Risk Assessment, Symptom Evaluation, Testing, and Management CAD = coronary artery disease; CCTA = cardiac computed tomography angiography; CPET = cardiopulmonary exercise testing; ECG = electrocardiogram.

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  Visual Summary. Coronary Artery Disease in Female Athletes CABG = coronary artery bypass grafting; CAD = coronary artery disease; CCTA = cardiac computed tomography angiography; LAD = left anterior descending artery; PCI = percutaneous coronary intervention.