[Symptoms and diagnosis of coronary heart disease in women].
BACKGROUND
Coronary heart disease in women is different from that in men with respect to symptoms, clinical presentation, value of the diagnostic tests and response to treatment. The article presents a review of symptoms and diagnostics of coronary heart disease in women and discusses the diagnostic procedures that are available.


METHODS
The review is based on literature identified through a non-systematic search of PubMed.


RESULTS
In general, myocardial infarction hits women about ten years later than men, but women with risk factors loose their sex advantage. Women with coronary disease are less likely to experience chest pain than men and may have less specific symptoms. Traditional non-invasive diagnostic investigations are less accurate than in men. Women with angina or myocardial infarction also have a lower prevalence of significant stenoses in coronary angiography, and atherosclerosis seems to be more diffuse than in men. This renders the diagnostic approach more difficult. Coronary CT angiography is a promising diagnostic technique, but few women have been included in studies of the method's accuracy, and the radiation dose is still relatively high.


CONCLUSIONS
We recommend a strategy that emphasizes risk stratification of patients, and thereafter identification of patients in need of further invasive testing. New techniques are needed to identify coronary heart disease in women.
Halvorsen
Sigrun
S
Hjertemedisinsk avdeling, Oslo universitetssykehus, Ullevål 0407 Oslo, Norway. sigrun.halvorsen@ulleval.no
Risøe
Cecilie
C
D000367:Age Factors; D000787:Angina Pectoris / Q000175:diagnosis* / Q000000981:diagnostic imaging; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000000981:diagnostic imaging; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000000981:diagnostic imaging; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012727:Sex Characteristics; D012737:Sex Factors; D014463:Ultrasonography