Q. Explain process of Stress Testing in Women?
Estrogen has been implicated as a cause of ST depression. For years it seemed that estrogen protect women from coronary artery disease. Also several reports tend to strongly link the hormone with exercise induced ST depression.
When testing women, the pretest likelihood cannot be ignored. Careful attention to the history of pain, medications, physical signs, and other lab signs of disease will go a long way toward helping to distinguish the true disease process. Mitral prolapse is often associated with ST depression in young pre menopausal women.
Rapid upsloping ST, increasing septal Q amplitude, and large P-waves suggesting the possibility of a large Ta wave can also alert us to the probability of a false positive test. If indicated thallium stress testing performed in high quality laboratories may add data to confirm or negate the results suggested by ST-segment depression after the standard exercise test has been completed. The ST/HR slope holds the most promise for a highly accurate exercise test in women. Angiography is indicated in certain clinical situations even when normal coronary arteries are suspected.