title: The enigma of heart disease in women: new insights may precipitate diagnosis and improve patient outcomes.
abstract: OBJECTIVE
  To highlight the unique pathophysiology and clinical presentation of ischemic heart disease in women. The article will emphasize the atypical clinical manifestations, reinforce the pitfalls of standard testing, and provide new insights into novel risk factors as well as diagnostic tools to enable earlier detection of disease.
  
  
  METHODS
  An extensive review of the literature was conducted using Pub Med and CINAHL databases. The reference lists of applicable published reports were also reviewed.
  
  
  CONCLUSIONS
  Significant evidence now exists to support the presence of coronary ischemia even in the absence of obstructive epicardial coronary occlusions. Coronary microvascular disease and/or endothelial dysfunction account for roughly 50% of heart disease cases in women. Understanding the different pathophysiologic mechanisms of coronary disease, the uncommon expression of symptoms, and the avoidance of over-reliance on standard testing to reveal disease is essential for early and accurate diagnosis.
  
  
  CONCLUSIONS
  A lack of awareness persists regarding the phenomenon of ischemic heart disease in women. Healthcare providers must optimize their understanding of these variations and implement strategies for early recognition and treatment. Evaluation of novel risk factors, coronary calcium screening, evaluation of endothelial function, and estimation of functional capacity offers significant advantages over traditional evaluations.
authors.affiliation: PICC Health Institute LLC, Houston, TX 77074, USA. mledwards@PICCHealthInstitute.com
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Edwards
mesh_terms: D002983:Clinical Competence; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D012307:Risk Factors; D012737:Sex Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D016387:Women's Health