What tests are used to diagnose heart disease in women?
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SCAI answered:For women, gauging overall risk for cardiovascular disease is a challenging proposition, especially if there are multiple risk factors to test for and monitor. If possible, work with your doctor to manage your risks and stay on track with your goals for a heart-healthy lifestyle.
Do you get a mammogram every year? That is very important. But what are you doing to check on your cardiovascular system? Depending on your risk factors, your primary care physician or cardiologist may recommend certain tests. It is always important to check your blood pressure and cholesterol, but it becomes especially important for women after menopause, even if you have never had symptoms of cardiovascular disease.
Do you know your cholesterol levels? The current government guidelines for the ideal LDL cholesterol level is 100mg/dL or below, especially if you have risk factors, such as high blood pressure, being overweight or a family history of heart disease. The target HDL cholesterol level is above 50 mg/dL for women. Your blood pressure should not go above 140/90 mmHg for long periods of time.
If you are concerned about your risk factors and especially if you have noticed any warning signs for heart attack or stroke, seek help. Your doctor may recommend further tests and possibly refer you to a cardiologist.
Several tests may be required to determine your risk of heart disease. These tests include blood tests, electrocardiography (EKG or ECG), echocardiography, magnetic resonance imaging (MRI), stress tests, computed tomographic angiography (CTA scan), ankle-brachial index test (ABI) and cardiac catheterization (angiography).
Men and women get heart disease, but how they get it and the best way to treat it may be different. And researchers are only beginning to understand some of these differences. In the WISE study, for example, researchers found that traditional diagnostic tests for heart disease may not be as reliable in women as they are in men because the nature of their disease may be different and not identified by the same tests. Stay tuned for more information as women and the medical community insist on greater enrollment of women in clinical trials.
For women, gauging overall risk for cardiovascular disease is a challenging proposition, especially if there are multiple risk factors to test for and monitor. If possible, work with your doctor to manage your risks and stay on track with your goals... More -
Dr. Sarah J Rinehart of Piedmont Heart Institute answered:In the world of cardiology today, there are a multitude of diagnostic tests and the problem is which test is correct for the individual patient and to balance the risks and benefits of each test modality.
The first thing that has to be assessed are each individual's cardiac risk factors. Blood pressure, cholesterol (low HDL and high LDL), tobacco, and advancing age are known cardiovascular risk factors. Typically, it has been known that blood pressure should be less than 140/90 but actually pre-hypertension starts at 120/80 and needs to be monitored. The HDL should be greater than 50 and triglycerides should be less than 150. The LDL targets are different depending on known risk factors and presence or absence of disease. Typically, the target for the LDL is less than 130 for no risk factors, less than 100 for an individual with risk factors, or less than 70 with presence of coronary artery disease, diabetes, or peripheral vascular disease.
However, family history is under-recognized. Poor functional capacity and presence of polycystic ovarian syndrome are risk factors that place a female at higher risk.
Calcium scoring is a good screening test for identification of early disease for females with risk factors who are asymptomatic to see if they need to be more agressive with their risk factors (LDL). If you are symptomatic, there are multiple choices which would include plain treadmill, stress echodcardiogram, nuclear stress testing, MR adenosine stress testing, and left heart catheterization.
Plain treadmills are a great first step but often have false positive reads in females. Therefore most females need an imaging form of stress test. CT angiogram is an excellent way of looking at the coronary arteries and can identify blockages that may be severe enough to cause symptoms but also can identify early disease in contrast to the other stress test which only identify if you have a blockage that may potentially cause symptoms (>70%). However, sometimes if you have a borderline blockage on CT, further testing is required. MR adenosine has an added benefit of identifying patients with "syndrome x."
One of the major concerns with females is the total amount of radiation. Stress echo and MRI have no radiation. CTA can range from 4-20 mSV (depends on scanner and heart rate), nuclear stress testing has between 12-20 mSv. Left heart catheterization is reserved for high risk patients.In the world of cardiology today, there are a multitude of diagnostic tests and the problem is which test is correct for the individual patient and to balance the risks and benefits of each test modality.The first thing that has to be assessed are... More
