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	James L. Holly, M.D.

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Your Life Your Health - Women and Heart Disease: Testing Guidelines

James L. Holly,M.D.

March 01, 2005

Cardiology Review March 2005, Vol 22 No 3

Women are less likely than men o have obstructive CAD.
Triple-vessel disease is more common in men.
Single vessel or non-obstructive disease is more common in women.
This has resulted in less diagnostic accuracy and higher false-positive rates for women.
Coronary Artery Disease usually appears 10-15 years later in women than in men.
Stress echocardiography and/or nuclear cardiography (myocardial perfusion imaging) are as accurate in women as men.
Abnormal studies from number 6, should advance a women to aggressive therapy and catherization if recommended.
Diabetes and CAD in women:
1. Diabetes wreaks havoc on he cardiovascular system.
2. Decreased pain perception can mask the symptoms of CAD in diabetic women.
3. Diabetic women merit special consideration as they have a risk of CV death that is up to eightfold higher than nondiabetic women.
4. Diabetes is a cardiovascular risk equivalent.
Carotid intima medial thickness should be utilized to look for sub clinical CAD.
Summary
1. Exercise treadmill ECG is the first step for women who can exercise and stay on the treadmill for more than 7 minutes and whose resting ECK is normal.
2. Cardiac imaging for women with diabetes or those with decreased functional capacity, using stress echocardiography or stress nuclear cardiography to decide who should proceed to catherization.

Other Articles in the Cardiovascular Disease in Women Series

	Women and Heart Disease: Congestive Heart Failure Women and Heart Disease: Primary Prevention Women and Heart Disease: Hormone Usage Women and Heart Disease: Hormone Replacement Therapy Women and Heart Disease: It can be prevented!

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