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Proposed approach for the evaluation and management of suspected ischemic heart disease in women. Our proposed approach for evaluating women with suspected ischemic heart disease begins with assessing the pretest probability of atherosclerotic cardiovascular disease (ASCVD), including an evaluation of anginal symptoms and symptoms associated with angina with nonobstructive coronary arteries (ANOCA). Next, we recommend coronary computed tomography angiography (CCTA) for low-risk patients and functional testing for high-risk patients. Patients with a large burden of ischemia on imaging should be placed on goal-directed therapy for obstructive coronary artery disease (CAD), and those with a low burden of ischemia can begin empiric medical therapy for ANOCA. Finally, in patients with persistent symptoms despite appropriate medical therapy, invasive coronary function testing can be pursued for a definitive diagnosis. CMR, cardiac magnetic resonance imaging; PET, positron emission tomography.