It can be difficult to make a timely and proper diagnosis in women who have coronary artery disease. The erroneous impression by physicians and the community that fewer women than men experience this disease plays a role. Timing of presentation and the spectrum of symptoms in women are somewhat different than in men. Once heart disease enters into the differential diagnosis, the choice of evaluation methods becomes a challenge. The variety of exercise or pharmacologic stress tests with decisions concerning the addition of nuclear techniques or echocardiography makes it important to understand the benefits and shortfallings of each modality. Pre-test probability of disease, the baseline ECG, accuracy, and expertise available all should be considered. Sometimes, technologies such as MRI, CT, or PET are useful. Whatever choice is made, it is vital to appreciate the high mortality and morbidity of coronary artery disease in women. Making prudent decisions to uncover their disease as early as possible allows appropriate treatment and risk factor modification.