Rev. DERC (Online) 2019; 25(2): 50-53

THE PARTICULARITIES OF THE INVESTIGATION OF CORONARY ARTERY DISEASE BY THE EXERCISE TESTING IN WOMEN

DOI: 10.29327/22487.25.2-3

ABSTRACT

Coronary artery disease (CAD) is the main cause of morbidity and mortality in women. One of the factors that hinders the early recognition of CAD is the clinical manifestation, since the symptoms are more atypical, and may appear as nausea, dyspnea, fatigue, epigastric discomfort, pain in dorsal, cervical or mandibular region. Women often have non-obstructive CAD associated with microvascular or endothelial dysfunction or other cardiovascular changes, which reduce the accuracy of noninvasive tests. Exercise testing (ET), one of the most used in the diagnosis of myocardial ischemia, has a low positive predictive value in the diagnosis of CAD in women. Some reasons for lower accuracy of the ET are: low electrocardiographic amplitude due to large breasts, autonomic and hormonal influences, lower levels of hemoglobin, smaller size of coronary arteries, higher prevalence of uniarterial coronary disease, inappropriate increase of catecholamines to effort and estrogen levels. Guidelines recommend indicating ET in women with intermediate risk, normal baseline electrocardiogram and aerobic condition greater than 5 MET, to improve accuracy of the method. Some variables may also contribute to improve prognostic value, such as: Duke score (adapted for women), exercise capacity, chronotropic index and heart rate recovery. Understanding the specific differences in the behavior of CAD in women, from the pathophysiology, clinical presentation and diagnostic procedures, must be fundamental for early detection of disease, to establish adequate treatment and, consequently, reduction of mortality.