Which test would be more beneficial for a woman to have to detect any heart problems – the Thallium stress test or the Cardiac CT Scan? I’ve already had numerous EKGs, an echo and Holter monitor. I read it is harder to detect heart problems with women because a lot of times the blockages are in the smaller arteries.
Non-invasive diagnostic and prognostic testing offers the potential to identify women at increased risk of heart disease in need of therapeutic intervention. For women with no symptoms, the Framingham risk score is used to assess the level of risk for having a heart attack or dying of heart disease in the next 10 years. To calculate your Framingham risk score, visit here. Current guidelines support diagnostic studies (stress testing with exercise electrocardiogram (ECG) or cardiac imaging) for symptomatic intermediate- to high-risk women. Imaging of low risk, symptomatic women (i.e., pre-menopausal women with < 1 risk factor and atypical symptoms) has been associated with a high rate of false positives and, therefore, is not recommended for widespread use. However, cardiac imaging should be considered for symptomatic women with multiple risk factors (i.e., the metabolic syndrome).
Treadmill testing with exercise ECG is the most often used form of stress testing to evaluate coronary artery disease (CAD) in women. Another commonly performed stress imaging test, gated myocardial perfusion single-photon emission computed tomography (SPECT), has been reported to have technical limitations in women, including false positive results due to breast attenuation and small left ventricular chamber size. The role of three new, non-invasive imaging technologies — computed tomography (CT), magnetic resonance imaging (MRI), and carotid intima-media thickness (IMT) — in the clinical evaluation of women with suspected CAD is still being determined. Briefly, coronary CT estimates the amount of coronary artery calcium, or atherosclerotic plaque burden, present in a normal vessel wall. However, it is not specific for showing how blocked the vessel is (luminal obstruction) and, therefore, is not recommended to diagnose obstructive coronary artery disease. Early work suggests a potential role for cardiovascular magnetic resonance imaging to evaluate the presence of CAD in symptomatic women. Subclinical atherosclerosis in the carotid artery has been extensively studied as a marker of CAD. Wide availability of ultrasound technology is an advantage of this test, lack of accepted technical standards for IMT testing and the absence of published population distributions of IMT are serious limitations of this test. Ongoing studies are evaluating the diagnostic significance of these technologies.
In summary, it’s best to discuss your cardiac risk level and symptoms with your physician so the appropriate diagnostic test(s) is used to evaluate the presence of CAD. If a standard exercise stress test is performed first, depending on the results of the test, your physician may recommend further tests such as a nuclear stress (i.e., thallium) test or cardiac catheterization.
Word of Advice:
Women, do not put off going to the doctor to get your annual check up. If you have no insurance or can’t afford insurance, please seek out free health clinics in your area by visiting http://www.freemedicalsearch.org/
Article Inspired by Dr. Lori Mosca MD, PhD
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