Women and Stress Testing

Exercise ECG

Exercise ECG (or ETT) is the most common type of stress testing.⁷ According to ACC/AHA guidelines, women should undergo exercise ECG if they have an intermediate pretest risk of CAD (based on risk factors and symptoms), have a normal resting ECG, and are capable of exercising^7,129 (see Algorithm for CAD Evaluation of Women).

ECG testing may have reduced sensitivity and specificity for diagnosing CHD in women as compared with men.^9,12,64 ECG in women has been shown to be variable and may be affected by women's smaller coronary vessels and hormonal status, among other factors.^9,64

Imaging for Women Unable to Exercise

In women, increased age at presentation and functional impairment are associated with lower exercise capacity and an inability to attain maximal stress.⁹ Women who are unable to perform a minimum of 5 METs of exercise may be candidates for MPI with pharmacologic stress.⁹ Approximately 40% of women referred for MPI are candidates for pharmacologic stress testing.⁹