Role of echocardiography in evaluation of women with chest pain

Abstract

This chapter reviews the role of echocardiography in evaluation of women with chest pain. Stress echocardiography is a well-established and diagnostically reliable modality for assessment of women with chest pain and suspected myocardial ischemia due to epicardial coronary artery disease. The technique is particularly suitable in women because of the lack of radiation and applicability in individuals who are or are not able to exercise. The chapter addresses the difficult issue of chest pain in women with angiographically normal coronary arteries, including prognostic role of stress echocardiography in these women, and newer echocardiographic techniques for assessment of coronary flow reserve and detection of microvascular disease. The importance of coronary flow reserve abnormalities in women with chest pain is examined. The chapter concludes with a discussion of the role of transthoracic echocardiography in assessment of two other important cardiac causes of chest pain in women with angiographically normal coronary arteries - hypertrophic cardiomyopathy and stress-induced cardiomyopathy. The typical echocardiographic features of both types of cardiomyopathies are reviewed. Also, the role of coronary flow reserve and myocardial contrast in clarifying the causes of ischemia in these entities is examined.