Chronic stable angina risk stratification electrocardiogram/chest x-ray

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Chronic stable angina Microchapters

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Patient Information

Overview

Historical Perspective

Classification

Classic
Chronic Stable Angina
Atypical
Walk through Angina
Mixed Angina
Nocturnal Angina
Postprandial Angina
Cardiac Syndrome X
Vasospastic Angina

Differentiating Chronic Stable Angina from Acute Coronary Syndromes

Pathophysiology

Epidemiology and Demographics

Risk Stratification

Pretest Probability of CAD in a Patient with Angina

Prognosis

Diagnosis

History and Symptoms

Physical Examination

Test Selection Guideline for the Individual Basis

Laboratory Findings

Electrocardiogram

Exercise ECG

Chest X Ray

Myocardial Perfusion Scintigraphy with Pharmacologic Stress

Myocardial Perfusion Scintigraphy with Thallium

Echocardiography

Exercise Echocardiography

Computed coronary tomography angiography(CCTA)

Positron Emission Tomography

Ambulatory ST Segment Monitoring

Electron Beam Tomography

Cardiac Magnetic Resonance Imaging

Coronary Angiography

Treatment

Medical Therapy

Revascularization

PCI
CABG
Hybrid Coronary Revascularization

Alternative Therapies for Refractory Angina

Transmyocardial Revascularization (TMR)
Spinal Cord Stimulation (SCS)
Enhanced External Counter Pulsation (EECP)
ACC/AHA Guidelines for Alternative Therapies in patients with Refractory Angina

Discharge Care

Patient Follow-Up
Rehabilitation

Secondary Prevention

Guidelines for Asymptomatic Patients

Noninvasive Testing in Asymptomatic Patients
Risk Stratification by Coronary Angiography
Pharmacotherapy to Prevent MI and Death in Asymptomatic Patients

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Case #1

Chronic stable angina risk stratification electrocardiogram/chest x-ray On the Web

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Risk calculators and risk factors for Chronic stable angina risk stratification electrocardiogram/chest x-ray

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [5]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [6]; Smita Kohli, M.D.; Lakshmi Gopalakrishnan, M.B.B.S.

Overview

The presence of ECG abnormalities at rest and pulmonary venous congestion on CXR are associated with reduced LVEF which remains an important prognostic factor in patients with chronic stable angina.

ECG

  • The presence of ECG abnormalities at rest puts the patient at higher risk than the absence of ECG abnormalities at rest.[1]
  • Rest ECG abnormalities that are associated with poor outcomes include:

Chest X-ray

The presence of cardiomegaly or pulmonary vascular congestion on chest X-ray is also associated with a poor prognosis.

ESC Guidelines- Clinical Evaluation and ECG for Risk Stratification (DO NOT EDIT) [7]

Class I

1. Detailed clinical history and physical examination including BMI and/or waist circumference in all patients, also including a full description of symptoms, quantification of functional impairment, past medical history, and cardiovascular risk profile. (Level of Evidence: B)

2. Resting ECG in all patients. (Level of Evidence: B)

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Guidelines Resources

References

  1. Hammermeister KE, DeRouen TA, Dodge HT (1979) Variables predictive of survival in patients with coronary disease. Selection by univariate and multivariate analyses from the clinical, electrocardiographic, exercise, arteriographic, and quantitative angiographic evaluations.Circulation59 (3):421-30. PMID: 761323
  2. (1980) Prospective randomised study of coronary artery bypass surgery in stable angina pectoris. Second interim report by the European Coronary Surgery Study Group. Lancet 2 (8193):491-5. PMID: 6105556
  3. Murphy ML, Hultgren HN, Detre K, Thomsen J, Takaro T (1977) Treatment of chronic stable angina. A preliminary report of survival data of the randomized Veterans Administration cooperative study. N Engl J Med 297 (12):621-7. [1] PMID: 331107
  4. Frank CW, Weinblatt E, Shapiro S (1973)Angina pectoris in men. Prognostic significance of selected medical factors. Circulation 47 (3):509-17. PMID: 4632503
  5. BLOCK WJ, CRUMPACKER EL, DRY TJ, GAGE RP (1952)Prognosis of angina pectoris; observations in 6,882 cases. J Am Med Assoc 150 (4):259-64. PMID: 14955434
  6. Ruberman W, Weinblatt E, Goldberg JD, Frank CW, Shapiro S, Chaudhary BS (1980)Ventricular premature complexes in prognosis of angina. Circulation 61 (6):1172-82. PMID: 7371129
  7. 7.0 7.1 Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F; et al. (2006). "Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology". Eur Heart J. 27 (11): 1341–81. doi:10.1093/eurheartj/ehl001. PMID 16735367.
  8. Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina). Circulation 99 (21):2829-48. [2]PMID: 10351980
  9. Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina). Circulation 107 (1):149-58.[3] PMID:12515758
  10. Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007)2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina. Circulation 116 (23):2762-72.[4] PMID:17998462

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