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Chest Pain / Angina Pectoris: Difference between revisions
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Chest Pain / Angina Pectoris (view source)
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! colspan = "7" | ECG = electrocardiogram; PTP = pre-test probability; SCAD = stable coronary artery disease. | ! colspan = "7" | ECG = electrocardiogram; PTP = pre-test probability; SCAD = stable coronary artery disease. | ||
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| colspan = "7" | <sup>a</sup> Probabilities of obstructive coronary disease shown reflect the estimates for patients aged 35, 45, 55, 65, 75 and 85 years. | | colspan = "7" bgcolor="#FFFFFF" | <b><sup>a</sup></b> Probabilities of obstructive coronary disease shown reflect the estimates for patients aged 35, 45, 55, 65, 75 and 85 years. | ||
*Groups in <i>white boxes</i> have a PTP <15% and hence can be managed without further testing. | *Groups in <i>white boxes</i> have a PTP <15% and hence can be managed without further testing. | ||
*Groups in <i>blue boxes</i> have a PTP of 15–65%. They could have an exercise ECG if feasible as the initial test. However, if local expertise and availability permit a non-invasive imaging based test for ischaemia this would be preferable given the superior diagnostic capabilities of such tests. In young patients radiation issues should be considered. | *Groups in <i>blue boxes</i> have a PTP of 15–65%. They could have an exercise ECG if feasible as the initial test. However, if local expertise and availability permit a non-invasive imaging based test for ischaemia this would be preferable given the superior diagnostic capabilities of such tests. In young patients radiation issues should be considered. | ||
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!74–91 | !74–91 | ||
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| colspan="3"| <b>CAD</b> = coronary artery disease; <b>CTA</b> = computed tomography angiography; <b>ECG</b> = electrocardiogram; <b>MRI</b> = magnetic resonance imaging; <b>PET</b> = positron emission tomography; <b>SPECT</b> = single photon emission computed tomography. | | colspan="3" bgcolor="#FFFFFF"| <b>CAD</b> = coronary artery disease; <b>CTA</b> = computed tomography angiography; <b>ECG</b> = electrocardiogram; <b>MRI</b> = magnetic resonance imaging; <b>PET</b> = positron emission tomography; <b>SPECT</b> = single photon emission computed tomography. | ||
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| colspan="3"|<sup>a</sup> Results without/with minimal referral bias. | | colspan="3"|<b><sup>a</sup></b> Results without/with minimal referral bias. | ||
<sup>b</sup> Results obtained in populations with medium-to-high prevalence of disease without compensation for referral bias. | <b><sup>b</sup></b> Results obtained in populations with medium-to-high prevalence of disease without compensation for referral bias. | ||
<sup>c</sup> Results obtained in populations with low-to-medium prevalence of disease. | <b><sup>c</sup></b> Results obtained in populations with low-to-medium prevalence of disease. | ||
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[[File:Algorithm_for_the_initial_evaluation_of_patients_with_clinical_symptoms_of_angina.svg|thumb|right|500px|Figure 1. Algorithm for the initial evaluation of patients with clinical symptoms of angina]] | |||
If the ECG made during exercise testing does not show any abnormalities myocardial ischemia becomes unlikely as cause of the complaints. If the diagnosis is still in doubt, the following additional tests may be performed. | If the ECG made during exercise testing does not show any abnormalities myocardial ischemia becomes unlikely as cause of the complaints. If the diagnosis is still in doubt, the following additional tests may be performed. | ||
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#Magnetic Resonance Imaging can be done with vasodilatory adenosine or stimulating dobutamine to detect wall motion abnormalities induced by ischemia during pharmacological stress. <Cite>REFNAME14</Cite> | #Magnetic Resonance Imaging can be done with vasodilatory adenosine or stimulating dobutamine to detect wall motion abnormalities induced by ischemia during pharmacological stress. <Cite>REFNAME14</Cite> | ||
The findings on stress testing can be used to determine the choice between medical therapy only or medical therapy and invasive assessment of the coronary anatomy in patients with stable angina. Coronary angiography is recommended based upon the severity of symptoms, likelihood of ischemic disease, and risk of the patient for subsequent complications including mortality based on risk scores. <Cite>REFNAME15</Cite> For the algorithm for the initial evaluation of patients with clinical symptoms of angina see Figure 1 | The findings on stress testing can be used to determine the choice between medical therapy only or medical therapy and invasive assessment of the coronary anatomy in patients with stable angina. Coronary angiography is recommended based upon the severity of symptoms, likelihood of ischemic disease, and risk of the patient for subsequent complications including mortality based on risk scores. <Cite>REFNAME15</Cite> For the algorithm for the initial evaluation of patients with clinical symptoms of angina <b>see Figure 1</b>. | ||
==Coronoary Angiography== | ==Coronoary Angiography== | ||