Evaluating women with chest pain for the diagnosis of coronary artery disease.
The evaluation of women with chest pain for the presence of important coronary artery disease may be challenging. Coronary artery disease is the leading cause of death, but it is much more prevalent in women of older age. However, chest discomfort is a very common symptom among women of all ages. Younger women are much less likely (but not completely immune) from having significant coronary disease, but the existing forms of cardiac testing are more likely to yield false results when applied to low-risk groups. Women should be assessed for their overall level of risk for coronary disease and the severity and nature of symptoms. Noninvasive cardiac testing is best applied to women at intermediate risk. There are strengths and weaknesses for each of the available imaging modalities, but both nuclear scans and echocardiography have reasonable accuracy and reliability for detecting serious coronary disease in women. Importantly, a negative study imparts an excellent prognosis. The application of a systematic and comprehensive evaluation of women will improve detection of important coronary disease and permit reassurance to women who do not have evidence for ischemia producing coronary disease. For women whose symptoms are determined not to be caused by significant coronary disease, additional evaluation for noncardiac causes can then be undertaken.
Limacher
Marian
M
Handberg
Eileen
E
D000367:Age Factors; D000465:Algorithms; D002637:Chest Pain / Q000209:etiology*; D003324:Coronary Artery Disease / Q000150:complications* / Q000175:diagnosis*; D003663:Decision Trees; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016387:Women's Health