Cardiovascular Disease in WomenModule IV Diagnosis.ppt

Cardiovascular Disease in WomenModule IV: Diagnosis  Diagnosis of Coronary Artery Disease in Women Drawbacks and Difficulties in Diagnosis Presentation in Women Diagnostic Testing Challenges Diagnosis of Coronary Artery Disease in Women Chest pain is experienced by most women with CHD, but non-chest pain presentations are more common in women than men Other Presenting Symptoms Upper abdominal pain, fullness, burning sensation Shortness of breath Nausea Neck, back, jaw pain Associations Precipitated by exertion Precipitated by emotional distress Testing for Ischemic Heart Diseasein Women and Factors to Consider Drawbacks of Diagnostic Imaging in Women Low exercise capacity – ?likelihood of reaching adequate pressure rate product Solution: Pharmacologic stress testing Breast attenuation artifact – higher false positive imaging studies Solution: Gated acquisition; attenuation correction for nuclear imaging Solution: Echocardiography Lower pretest probability of CAD – higher false positive rate Solution: Integrate clinical variables, risk factors, into decision-making process Value of the Exercise ECG in Women Principles of Nuclear Cardiac Stress Testing Normal response: Myocardial blood flow demonstrated by injected radioisotopes is increased above the resting condition Ischemia: With fixed stenoses, myocardial perfusion does not increase with stress in the territory supplied by the stenosed artery, demonstrated by inhomogeneous distribution of the radioisotope Scar from myocardial infarction: Fixed inhomogeneous distribution of the radioisotope at both rest and with stress Photons are emitted in all directions from the point of origin Attenuation of images occurs in obese patients, and from breast tissue Diagnostic Accuracy of Thallium-201 SPECT Myocardial Perfusion Imaging in Men and Women Sensitivity and Specificity of Dipyridamole SPECT Imaging in Identifying Individual Coronary Stenoses and Multivessel Disease in Women Breast Attenuation Breast Attenua