Does the natural history of atherosclerotic CAD differ in females and males?

Yes. The Framingham Study has shown that 23% of all female mortality and 52% of all cardiovascular female deaths are due to atherosclerotic CAD, whereas figures for males are 34% and 64%, respectively. Sudden cardiac death is less common in women, and women manifest symptoms approximately 10 years later than men.

Do women and men present with the same symptoms when they have CAD?

What tests are used for diagnosing CAD in women?

The exercise treadmill test is of limited value in the diagnosis of CAD in women, having a sensitivity and specificity of 70%; however, the addition of thallium increases the specificity to 90%. Radionuclear ventriculography with exercise has also been disappointing in diagnosing CAD in females. The diagnostic accuracy for the presence of CAD is increased with stress testing in women if two or more cardiac risk factors are present; mitral valve prolapse is excluded; the ST segments normalize after 6 minutes into recovery; target heart rate is achieved; or exercise duration is 5 minutes on a full Bruce protocol.

Why is thallium perfusing imaging less sensitive in diagnosing CAD in women?

Though studies predominantly in men show exercise thallium perfusion imaging to improve the sensitivity of the stress test for CAD diagnosis, in women with single-vessel and multivessel disease the sensitivity is lower. This may be influenced by women’s inability to attain target heart rate, low exercise levels, or imaging artifact from breast attenuation.

Is there another test to diagnose CAD in women before going to angiography?

Exercise echocardiography has been shown to have excellent accuracy, independent of chest pain being typical or atypical and the prevalence of CAD in women. Also, exercise echocardiography can detect noncoronary causes of chest pain, such as mitral valve prolapse, pericardial effusion, pulmonary hypertension, hypertrophic cardiomyopathy, and valvular disease. Coronary angiography should be used when noninvasive risk stratification and testing suggest a high probability of significant CAD. Women who despite medical therapy are symptomatic during

low-level exercise in their daily routine or who have had frequent noninvasive testing for multiple bouts of chest pain (even with minimal risk factors) should be considered for coronary angiography.

Does the natural history of atherosclerotic CAD differ in females and males? Photo Gallery

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