Hi - I've posted previously - my doc has ordered a stress test because of some "S-T' depressions he saw on the 24 hour Holter monitor.
Now someone has told me that for women, the thallium test is more accurate, that the regular stress test is not accuraate about 50% of the time! Is this true? Am I supposed to tell my doctor what to do?
Dear Donna Sue,
There is no doubt that a exercise stress test on the treadmill (no imaging with thallium or echo.) is less sensitive in the detection of potential coronary heart disease in women as compared to men.
The decision of whether or not to get a stress test and whether or not to image in addition to the EKG portion is based not on sex, but more importantly on the patient's risk factors for coronary artery disease, the symptoms that patient is experiencing, and what exactly it is the physician intends to gain in the form of information from the test.
For example, the exercise(treadmill or bike)EKG stress test can be done to assess functioal capacity of the patient, and in a patient who has difficulty walking the exercise can be replaced with medicines given temporarily that mimic stress in some way. For the sake of your question I am going to assume the question raised by your ST depressions on Holter is whether or not you have coronary artery disease.
The American College of Cardiology/American Heart Association Task Force subcommittee on exercise testing published indications for exercise electrocardiogram testing in The Journal of the American College of Cardiology in 1986 which included the following entries that might be pertinent to your situation: exercise ecg is possibly indcated in the diagnosis of coronary artery disease in women with typical or atypical symptoms, and
exercise ecg is probably not indicated in the evaluation of asymptomatic men or women.
You might also want to know that given there is such a low sensitivity for coronary heart disease by exercise ecg in women (about 50% ability to pick up the disese if present)it is recommended that the test includes use of the heart rate adjusted criteria that has been shown to improve test accuracy in women.
Because medicine is art and science, it is not simply that men get exercise ecg and women get thallium with exercise ecg. It would therefore be in your best interest to ask your physician to explain why this particular test has been ordered for you and what he intends to do with the results. It is always the discretion of the patient to seek a second opinion at any time but especially if he/she does not feel comfortable with the care he/she is receiving.
Also know that never should a patient enter in to any testing situation or evaluation if he/she is not comfortable or aware of the potential risks and benefits of the cardiovascular procedure. Information provided in the Heart Forum is intended for general informatioal purposes only, actual diagnosis, treatment, and testing can only be performed by your physician(s).
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