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Spectrum of Ischemic Heart Disease Throughout a Woman’s Life Cycle Cover

Spectrum of Ischemic Heart Disease Throughout a Woman’s Life Cycle

Methodist DeBakey Cardiovascular Journal
Volume 20 (2024): Issue 2
By: ,   and    
Open Access
|Mar 2024
Figures & tables

Figures & Tables

Figure 1

Yip-Saw angiographic classification for spontaneous coronary artery dissection (SCAD).

Figure 2

Invasive coronary angiogram of type 3 spontaneous coronary artery dissection (SCAD) in a 54-year-old woman presenting with non-ST-elevation myocardial infarction (NSTEMI). Type 3 SCAD is the most difficult type to distinguish from obstructive coronary artery disease.

Table 1

American Heart Association, American College of Cardiology, and European Society of Cardiology guidelines for the management of patients with chronic coronary artery disease. COVADIS: Coronary Vasomotor Disorders International Study Group; CMD: coronary microvascular disease; CAD: coronary artery disease; FFR: fractional flow reserve; CTA: computed tomography angiography; ECG: electrocardiography; IMR: microcirculatory resistance; TIMI: Thrombolysis in Myocardial Infarction

COVADIS DIAGNOSTIC CRITERIA FOR CMD
Symptoms of myocardial ischemia

  • Effort and/or rest angina

  • Angina equivalents (ie, shortness of breath)

Absence of obstructive CAD (< 50% diameter reduction or FFR > 0.80) by

  • Coronary CTA

  • Invasive coronary angiography

Objective evidence of myocardial ischemia

  • Ischemic ECG changes during an episode of chest pain

  • Stress-induced chest pain and/or ischemic ECG changes in the presence or absence of transient/reversible abnormal myocardial perfusion and/or wall motion abnormality

Evidence of impaired coronary microvascular function

  • Impaired coronary flow reserve (cut-off values depending on methodology use between ≤ 2.0 and ≤ 2.5)

  • Coronary microvascular spasm, defined as reproduction of symptoms, ischemic ECG shifts but no epicardial spasm during acetylcholine testing

  • Abnormal coronary microvascular resistance indices (eg, IMR > 25)

  • Coronary slow flow phenomenon, defined as TIMI frame count > 25

Figure 3

Positron emission tomography with myocardial flow reserve (MFR) showing normal perfusion with impaired MFR of 1.84 (normal MFR > 2) in a 76-year-old woman with microvascular angina. LV: left ventricular; LAD: left anterior descending artery; LCx: left circumflex artery; RCA: right coronary artery

Figure 4

Spectrum of ischemic heart disease (IHD) in women. SCAD: spontaneous coronary artery dissection; FMD: fibromuscular dysplasia; DM2: diabetes mellitus type 2; CAD: coronary artery disease; CV: cardiovascular; CMD: coronary microvascular dysfunction; INOCA: ischemia with no obstructive coronary arteries; MINOCA: myocardial infarction with no obstructive coronary arteries; VSA: vasospastic angina; ACE: angiotensin converting enzyme; AT1: angiotensin 1 receptor; HTN: hypertension

DOI: https://doi.org/10.14797/mdcvj.1331 | Journal eISSN: 1947-6108
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Language: English
Page range: 81 - 93
Submitted on: Dec 20, 2023
Accepted on: Jan 10, 2024
Published on: Mar 14, 2024
Published by: Houston Methodist DeBakey Heart & Vascular Center
In partnership with: Paradigm Publishing Services
Keywords:
MINOCA,
INOCA,
vasospasm,
coronary microvascular dysfunction,
SCAD,
ischemic heart disease in women

© 2024 Smitha Narayana Gowda, Sai Sita Garapati, Karla Kurrelmeyer, published by Houston Methodist DeBakey Heart & Vascular Center
This work is licensed under the Creative Commons Attribution-NonCommercial 4.0 License.

Volume 20 (2024): Issue 2
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