Proceed with caution: reliance on coronary angiography to exclude organic disease in women. Nuclear Cardiology

摘要

Coronary artery disease (CAD) is a pleomorphic disease with a wide spectrum of initial clinical presentations, ranging from minor vague symptoms to unheralded sudden cardiac death. In clinical samples already suspected of having CAD, the presence or absence of symptoms, per se, is a relatively poor predictor of future cardiac events.1 Moreover, symptoms or their absence does not predict the presence or absence of inducible myocardial ischemia. Rather, "silent" myocardial ischemia occurs commonly both during exercise testing and during activities of daily living.2 The converse is also true: typical anginal chest pain may frequently occur without objective signs of myocardial ischemia.3 Thus the skillful clinician realizes that the diagnosis of CAD is not subject to a "cookbook approach." Seasoned clinical judgment is very important.