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    Stress Tests and Angioplasty for Women

    Stress tests do just what the name implies-they stress your body. When exercising, your heart needs more blood and energy than if you were resting. When doing a stress test, a patient is monitored for symptoms such as chest pain, shortness of breath and dizziness, which can indicate heart disease.

    A stress test may also be ordered after procedures such as coronary bypass surgery or balloon angioplasty, to help design safe rehabilitation programs. They are also frequently used to diagnose coronary artery disease (CAD), which occurs when fat, cholesterol and other substances build up inside the walls of the coronary arteries and eventually block off the passage.

    There are a number of different test options, and doctors will choose the one most appropriate for the individual. Selecting the most appropriate stress test for a female patient, says cardiac expert Lynne L. Johnson, MD, of Providence Hospital/Brown University in Rhode Island, requires a clinical review that including a patient's age, symptoms, risk profile and functional capacity.

    Addressing an audience at the annual meeting of the American College of Physicians/American Society for Internal Medicine, in Philadelphia, Johnson gave an overview of information designed to help doctors select the most appropriate type for their female patients.

    According to Johnson, a treadmill is an appropriate stress test for younger women with suspected CAD and who are not diabetic. The results of the test would then determine what further evaluations are needed. If she is older and especially if she is diabetic, than a stress perfusion imaging test is recommended instead of a treadmill. For both men and women, stress perfusion imaging is more sensitive in diagnosing CAD.

    A stress echocardiogram can also be done for women who are not good candidates for the treadmill, and it compares with the stress perfusion imaging test as far as sensitivity and accuracy.

    Pharmacological stress tests, Johnson says, should be reserved for women who are unable to exercise. This type of test involves using drugs which mimic exercise or that evaluate the blood flow.

    In a related presentation, Malcolm R. Bell, MD, from the Mayo Clinic in Rochester, MN, discussed how gender affects coronary angioplasty, a procedure used to clear blocked arteries. During angioplasty, a balloon-tipped catheter is threaded into a blocked artery and inflated, flattening fatty plaques against the artery wall.

    Success rates, says Bell, do not differ significantly between men and women. However, he cites that numerous observational studies have shown that the death rates that occur while the patients are still in hospital, or soon after surgery, are higher among women. The reasons for this difference are not clear. One hypothesis is that women may be diagnosed later, when the disease is more advanced, or there may be gender bias on the part of the physician and thus a delay in treatment. A recent study known as the BARI trial, did not show any difference in outcome between the two sexes.

    When choosing whether a woman with CAD is a candidate for angioplasty or coronary artery bypass surgery, Bell says that the guidelines and criteria should be the same for both men and women.



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