Women with suspected ischemic heart disease

Heart disease remains the number one cause of death in women worldwide, and important sex differences in the rates of diagnosis, utilization of care, response to therapy, and clinical outcomes have been described. Designed primarily for the identification of obstructive coronary artery disease (CAD), conventional diagnostic testing approaches in the evaluation of ischemic heart disease (IHD) can lead to under- or overtesting in women without differentiating those truly at risk. Unique factors related to the presentation, diagnosis, and underlying pathophysiology of IHD in women underscore the need for a more tailored approach to their evaluation. This chapter, with accompanying case vignettes, reviews how nuclear cardiology and multimodality cardiovascular imaging tools are being applied to better reflect pathological phenotypes prevalent in women, including ischemia with no obstructive CAD and coronary microvascular dysfunction, to aid in the development of needed evidence-based strategies for their management.