title: Women and Chest Pain: Recognizing the Different Faces of Angina in the Emergency Department.
abstract: Emergency departments (ED) in the United States see over eight million cases of chest pain annually. While a cardinal symptom of acute coronary syndrome (ACS), multiple emergent and non-emergent causes can attribute to chest pain. This case-based perspective describes the different sex-specific causes of angina seen in ED patients. Once coronary artery disease (CAD) is ruled out with standard protocols, microvascular dysfunction is perhaps the most prevalent but under-diagnosed cause of non-CAD related angina in ED patients. Additional causes include coronary artery spasm, coronary artery dissection, coronary artery endothelial dysfunction and myocardial bridging. Non-CAD related angina is associated with persistent chest pain causing poor function, quality of life, and recidivism. Clinicians should consider additional diagnostics to routinely screen for non-CAD related causes of angina in patients with recurrent chest pain. Future work is needed to better define the epidemiological, clinical, biological, and genetic correlates of microvascular dysfunction in these patients.
authors.affiliation: Department of Emergency Medicine Yale University School of Medicine, New Haven CT.
authors.forename: Basmah
authors.initials: B
authors.lastname: Safdar
authors.affiliation: Department of Emergency Medicine Yale University School of Medicine, New Haven CT.
authors.forename: Gail
authors.initials: G
authors.lastname: D'Onofrio
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis; D000328:Adult; D000368:Aged; D002637:Chest Pain / Q000175:diagnosis* / Q000209:etiology; D003324:Coronary Artery Disease / Q000175:diagnosis; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011788:Quality of Life
keywords: chest pain; gender; microvascular disease; sex; women