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Diagnosing Coronary Artery Disease in Women: An Update on Cardiac Imaging Modalities

Litwin, Sheldon E. MD; Priester, Tiffany C. MD

doi: 10.1097/AOG.0b013e3181c6f7f4
Clinical Expert Series
Expert Discussion

Coronary heart disease (CHD) remains the leading cause of death in women. However, there are multiple challenges to the diagnosis of CHD in women, including: 1) women perceive their risk of CHD to be lower than it truly is, 2) women frequently present with atypical cardiac symptoms, 3) traditional stress tests have lower accuracy in women than in men, 4) women have a lower frequency of obstructive CHD detected at angiography than do men, and 5) a high percentage of women without obstructive CHD by invasive angiography have recurrent chest pain. Given the increasing number of options and complexity of noninvasive testing for CHD, it is important for women's health care providers to select the best test for a given patient. Newer imaging modalities such as cardiac computed tomography and magnetic resonance imaging offer speed, convenience, and high diagnostic accuracy in women. The goal of this article is to provide practitioners with an overview of the conventional diagnostic tests and to compare these with the newer imaging modalities. The appropriate application of diagnostic tests should allow practitioners to identify accurately and reassure those patients who are at low risk while targeting those who have preclinical or symptomatic atherosclerosis so that they can receive aggressive medical therapy, referral to cardiovascular specialists, or both.

Cardiac computed tomography and magnetic resonance imaging have higher diagnostic accuracy rates for noninvasive detection of coronary disease in women compared with traditional stress testing. SUPPLEMENTAL DIGITAL CONTENT IS AVAILABLE IN THE TEXT.

From the Cardiology Division, University of Utah, Salt Lake City, Utah.

Continuing medical education for this article is available at

Corresponding author: Sheldon Litwin, Cardiology Division 4A100 SOM, University of Utah, 30 N 1900 E, Salt Lake City, UT 84132; e-mail:

Financial Disclosure: Dr. Litwin has received honoraria from Siemens. The other author did not report any potential conflicts of interest.

© 2010 by The American College of Obstetricians and Gynecologists.