Diagnosing Coronary Artery Disease in Women

Abstract

Coronary heart disease (CHD) remains the leading cause of death in women. However, there are multiple challenges to the diagnosis of CHD in women, including: 1) women perceive their risk of CHD to be lower than it truly is, 2) women frequently present with atypical cardiac symptoms, 3) traditional stress tests have lower accuracy in women than in men, 4) women have a lower frequency of obstructive CHD detected at angiography than do men, and 5) a high percentage of women without obstructive CHD by invasive angiography have recurrent chest pain. Given the increasing number of options and complexity of noninvasive testing for CHD, it is important for women's health care providers to select the best test for a given patient. Newer imaging modalities such as cardiac computed tomography and magnetic resonance imaging offer speed, convenience, and high diagnostic accuracy in women. The goal of this article is to provide practitioners with an overview of the conventional diagnostic tests and to compare these with the newer imaging modalities. The appropriate application of diagnostic tests should allow practitioners to identify accurately and reassure those patients who are at low risk while targeting those who have preclinical or symptomatic atherosclerosis so that they can receive aggressive medical therapy, referral to cardiovascular specialists, or both.