Characteristic Symptoms in Women with Ischemic Heart Disease

Advances in coronary imaging techniques have revealed that there are important sex differences in the pattern of ischemic heart disease. In this review, we aim to summarize our current knowledge and focus on the relation between a distinct symptom presentation in women and their underlying type of coronary artery disease. Women in the age group 40–70 years more often have non-obstructive coronary artery disease (CAD) and coronary vasomotor disorders compared with the traditional obstructive CAD as seen in men. These differences in pathophysiology translate into another symptom presentation which we should rather call characteristic than atypical. Women at risk for coronary vasomotor disorders often have co-morbidities and an enhanced pro-inflammatory state, which leads the way to the appropriate diagnosis. Progress has been made with invasive testing to better discriminate between coronary spasm and microvascular dysfunction. Treatment options are still limited and often disappointing for this heterogeneous patient population. Sex differences in ischemic heart disease truly exist and have been clearly defined over the past years. We should therefore approach female patients according to this acquired knowledge. The challenge for the coming years will be a more tailored diagnostic and therapeutic approach for symptomatic women at middle-age.