While obstructive atherosclerosis is the most common etiology of MI and ischemia in women, it is just the tip of the iceberg when considering the diverse pathological mechanisms of coronary arterial function and disease in women. Coronary microvascular dysfunction and coronary vasospasm are common causes of ischemia with no obstructive coronary arteries (INOCA). Spontaneous coronary artery dissection (SCAD) is a cause of MI that can have an obstructive or nonobstructive angiographic appearance. MI in the setting of no obstructive coronary arteries (MINOCA) can be attributed to coronary vasospasm (epicardial or microvascular), thromboembolism, plaque rupture, or plaque erosion. Elevated troponin in women may also be due to non-MI etiologies, including myocarditis, nonischemic cardiomyopathy, and Takotsubo Syndrome. INOCA, ischemia with no obstructive coronary arteries; MI, myocardial infarction; MINOCA, myocardial infarction with no obstructive coronary arteries; SCAD, spontaneous coronary artery dissection. (Illustration credit: Julia Huang and Ben Smith).