Diagnostic testing to evaluate ischemic symptoms in women.

Abstract

Chest pain is a common problem in women. There are many diagnostic strategies available to evaluate patients with chest pain for suspected ischemic heart disease (IHD), each with special considerations for sex differences in presentation and test characteristics. Stable angina is the most frequent manifestation of IHD in women, affecting approximately 4,200,000 (3.2%) women in the USA, and the age-adjusted prevalence of angina is greater in women than men [1–4]. Women with stable angina report more physical limitations and lower quality of life, and suffer from a greater number of nonfatal myocardial infarctions (MIs) and deaths compared with men after 1–2 years [5–7]. This underscores the importance of identifying IHD in women initially presenting with chest pain and other related ischemic symptoms. For patients with suspected IHD noninvasive stress testing is recommended as the first study to confirm diagnosis and risk stratify patients as per current guidelines from the American College of Cardiology (ACC) and American Heart Association (AHA) [8]. Computed tomography (CT) angiography is another choice for patients with symptoms and suspected ischemia. Symptomatic women are less likely than men to undergo stress testing [6–9]. This editorial addresses the challenges in selecting an initial diagnostic test for a woman with possible ischemic symptoms and proposes strategies for choosing the most appropriate first test to diagnose and risk-stratify women with suspected IHD.