Expand your idea of ischemic heart disease to include non-obstructive patterns, which as our guest, Dr Noel Bairey Merz, a clinical investigative cardiologist whose multiple roles include Director of the Barbra Streisand Women’s Heart Center and the Preventive Cardiac Center at the Smidt Cedars-Sinai Heart Institute, shares with us, is incredibly common, especially in women.  Learn to recognize these women and treat according to guidelines, preventing unnecessary IHD mortality in our female (and some male) patients. We review a variety of non-obstructive pathologies and the best techniques to evaluate them. Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written and produced by: Shreya Trivedi MD, Molly Heublein MD Hosts: Paul Williams MD, FACP; Shreya Trivedi MD; Molly Heublein MD Edited by: Matthew Watto MD, FACP; Emi Okamoto MD Graphics by: Hannah Abrams Guest: Dr. C Noel Bairey Merz MD, FACC, FAHA Curbsiders' Schwag! We’ve got the perfect father’s day gift for every internal medicine nerd. The Curbsiders have opened our own online shop. Get your Curbsiders t-shirts, hoodies, stickers, and coffee mugs. Help support the show and gain instant bragging rights. Note: All purchases come with admitting privileges at Kashlak Memorial Hospital! Time Stamps 00:00 Intro, disclaimer and guest bio 04:36 Guest one-liner; Advice for success in research and clinical practice 07:07 A case of shortness of breath and chest tightness; Why the paradigm of obstructive coronary artery disease is flawed. 12:04 Why is there a sex difference in ischemic heart disease? 14:52 How to recognize ischemic heart disease in women; Are certain symptoms more likely in women; Categorizing angina 20:13 Who needs stress testing?; Screening for ischemic heart disease in women 24:52 How guidelines make good doctors great doctors 27:00 Diagnosis of NSTEMI in a woman without obstructive coronary disease 29:33 Medical therapy for non-obstructive ischemic heart disease 33:18 Additional testing: Cardiac MRI for myocarditis; perfusion reserve testing; CT coronary angiograms 35:48 How current non-invasive techniques fail to identify microvascular ischemic heart disease in women 39:10 Antianginal therapy 41:40 HFpEF in women 47:10 Weight loss for paroxysmal atrial fibrillation 48:45 New nomenclature for ischemic heart disease 50:18 Take home points 52:40 Outro