What are the indications for cardiac testing in women?

Updated: Nov 20, 2018
  • Author: Richard S Krause, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Cardiovascular disease is the leading cause of death for women in the United States, but a considerable body of research has demonstrated that women have different patterns of coronary artery disease and different responses to cardiac testing than their male counterparts. Women are more likely to have nonobstructive or single-vessel disease when compared with men, which decreases the diagnostic accuracy of stress testing. For example, treadmill testing in one meta-analysis was shown to have a sensitivity and specificity of 61% and 70%, respectively, for women compared with 72% and 77%, respectively, for men. [43]

Calcium scoring is limited because women tend to have 3- to 5-fold greater mortality rates for a given calcium score than men, suggesting that separate guidelines for interpreting scores in women should be developed.

Single photon emission computed tomography (SPECT) imaging is technically limited in women because breast tissue and relatively small left ventricle size can generate false-positive results. Technetium is less prone to attenuation artifacts than thallium and thus has higher specificity. The American Heart Association has recommended exercise tolerance testing as the initial noninvasive test of choice for symptomatic woman who are at intermediate risk for ischemic heart disease, have a normal baseline electrocardiogram, and are able to exercise. [44]

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