5. What are the typical symptoms of coronary artery disease?

The most typical symptom of significant coronary artery disease is chest pain, also known as angina. Angina is discomfort that occurs in the chest when the heart muscle does not get enough oxygen-rich blood. Chest pain typically occurs in the middle or left side of the chest and is triggered by physical or emotional stress. The pain typically subsides with cessation of the stressful activity. Shortness of breath with exertion or extreme fatigue may be other common symptoms that suggest underlying coronary artery disease.

6. How do the symptoms differ in women?

The signs and symptoms of coronary heart disease may differ between women and men. Although the most common presentation of coronary ischemia in women is left-sided chest pain, women can more commonly present with atypical symptoms. Women are much more likely to present with nonspecific symptoms, like neck pain, indigestion, nausea, vomiting or extreme fatigue. Shortness of breath and decreased exercise tolerance are also common. It is important for both the patient and the doctor to understand that women present atypically so a heart attack can be recognized and diagnosed early and treated promptly.

7. What constitutes higher risk for coronary artery disease in some women?

The classic modifiable risk factors include smoking, hypertension, high cholesterol, obesity, and diabetes. In general women have the same classic risk factors for developing coronary artery disease as men. However, some risk factors may affect women differently than men. For example, diabetes raises the risk of coronary artery disease more in women. Perhaps this is because women with diabetes more often have added risk factors, like obesity, hypertension and high cholesterol. Although women typically develop heart disease 10 years later than men, diabetes erases that advantage. Women who smoke are twice as likely to have a heart attack as male smokers. Women are also less likely to succeed in quitting and women who do quit are more likely to start again. The use of birth control pills can increase the risk for the development of coronary artery disease, especially in women older than 35. Women who smoke and take birth control pills are at a much higher risk and these pills should be discontinued in women who smoke.