Rev. DERC (Online) 2020; 26(1): 34-38
Ischemic Disease in Women Beyond Aterosclerosis
Abstract
Ischemic heart disease is a major global cause of morbidity and premature death and guidelines for diagnosis and treatment are predominantly shaped by the atherosclerotic plaque burden of epicardial coronary artery disease (CAD). However, recent studies have reported the diverse spectra and etiopathogenesis of chronic CAD, including in addition to atherosclerosis, coronary vasculature disorders, such as microvascular and vasospastic angina.
Ischemia without obstructive CAD is increasingly recognized and can be caused by transient and/or sustained damage in myocardial perfusion, which can be structural and/or functional, involve the coronary artery and/or its microcirculation. Patients with symptoms and signs of ischemia, without obstructive CAD present a challenge for diagnosis and treatment.
In addition, it is worth mentioning the differences observed between genders, as epicardial coronary heart disease occurs more frequently in men, while functional disorders (microvascular and vasospastic angina) are more common in women and are often undiagnosed and untreated.
In this clinical case, the diagnosis of myocardial ischemia without obstructive epicardial CAD motivated a change in lifestyle and an increase in cardiovascular therapy, extremely important in improving the patient’s quality of life and reducing the ischemic burden observed in myocardial perfusion scintigraphy.
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