Cardiovascular disease is the leading cause of death in Latin America. The increasing prevalence of diabetes mellitus (DM), coupled with modern lifestyle and population aging are contributing to increase ischemic heart disease (IHD)-related deaths in this region. Diagnosis of IHD in women can be challenging as they often present with no chest pain or atypical symptoms, delaying diagnosis and appropriate management. Women tend to have more advanced coronary artery disease (CAD), to be older, and have worse prognosis than men after myocardial infarction and bypass surgery. Life expectancy is usually higher for women but myocardial perfusion abnormalities, especially severe, predict increased mortality. This review will discuss IHD in Latin America women. Data from one of the largest nuclear cardiology registries in the world, involving 41,671 patients undergoing single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) in a referral center in Brazil, will be shown to illustrate the role of nuclear cardiology to evaluate women in this region. DM was prevalent at 22 %. Women (n = 18,629), when compared to men (n = 23,043), were found (1) to be less likely to have a history of prior CAD (20.9 vs 35 %); (2) to have a high abnormality rate on SPECT-MPI, although lower than men (27 vs 35 %); and (3) to be less able to perform exercise stress, requiring more pharmacological stress than men (36.3 vs 24.2 %). Our data shows that 87 % of the 5027 women found to have abnormal SPECT-MPI had no typical symptoms, presenting either no chest pain (50 %) or atypical pain (37 %), some having high-risk perfusion findings.