Chronic stable angina risk stratification in asymptomatic patients by noninvasive testing: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
(/* Noninvasive Testing for the Diagnosis of Obstructive CAD and Risk Stratification in Asymptomatic Patients (DO NOT EDIT){{cite journal| author=Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al.| title=ACC/AHA 2002 guideline...)
Line 5: Line 5:
==ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina (DO NOT EDIT)<ref name="pmid12570960">{{cite journal| author=Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al.| title=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). | journal=J Am Coll Cardiol | year= 2003 | volume= 41 | issue= 1 | pages= 159-68 | pmid=12570960 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12570960  }} </ref>==
==ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina (DO NOT EDIT)<ref name="pmid12570960">{{cite journal| author=Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al.| title=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). | journal=J Am Coll Cardiol | year= 2003 | volume= 41 | issue= 1 | pages= 159-68 | pmid=12570960 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12570960  }} </ref>==


===Noninvasive Testing for the Diagnosis of Obstructive CAD and Risk Stratification in Asymptomatic Patients (DO NOT EDIT)<ref name="pmid12570960">{{cite journal| author=Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al.| title=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). | journal=J Am Coll Cardiol | year= 2003 | volume= 41 | issue= 1 | pages= 159-68 | pmid=12570960 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12570960  }} </ref>===
===Noninvasive Testing for the Diagnosis of Obstructive CAD and Risk Assessment Recommendations(DO NOT EDIT)<ref name="pmid12570960">{{cite journal| author=Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al.| title=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). | journal=J Am Coll Cardiol | year= 2003 | volume= 41 | issue= 1 | pages= 159-68 | pmid=12570960 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12570960  }} </ref>===
 
====Advanced Testing: Resting and Stress Noninvasive Testing====
 
'''Resting Imaging to Assess Cardiac Structure and Function'''
{|class="wikitable"
{|class="wikitable"
|-
|-
| colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]


|-
|-
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' [[Chronic stable angina exercise electrocardiography|Exercise ECG]] testing without an imaging modality in asymptomatic patients with possible [[myocardial ischemia]] on [[Chronic stable angina ambulatory ST segment monitoring|ambulatory ECG]] monitoring or with [[coronary calcification]] on [[Chronic stable angina electron beam tomography|EBCT]] but with the baseline [[ECG]] abnormalities listed under Class IIb1 above. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Assessment of resting left ventricular (LV) systolic and diastolic ventricular function and evaluation for abnormalities of myocardium, heart valves, or pericardium are recommended with the use of Doppler echocardiography in patients with known or suspected
IHD and a prior MI, pathological Q waves, symptoms or signs suggestive of heart failure, complex ventricular arrhythmias, or an undiagnosed heart murmur ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''2.''' [[Chronic stable angina exercise electrocardiography|Exercise ECG]] testing without an imaging modality in asymptomatic patients with an established diagnosis of [[CAD]] owing to prior [[MI]] or [[coronary angiography]]; however, testing can assess functional capacity and prognosis. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''3.''' [[Chronic stable angina exercise echocardiography|Exercise echocardiography]] or [[dobutamine]] [[echocardiography]] in asymptomatic patients with [[left bundle-branch block]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''4.''' [[Adenosine]] or [[dipyridamole]] myocardial perfusion imaging or [[dobutamine]] [[echocardiography]] in asymptomatic patients who are able to exercise and who do not have [[left bundle-branch block]] or electronically paced ventricular rhythm. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''5.''' Exercise myocardial perfusion imaging, [[Chronic stable angina exercise echocardiography|exercise echocardiography]], [[adenosine]] or [[dipyridamole]] myocardial perfusion imaging, or [[dobutamine]] [[echocardiography]] after [[Chronic stable angina exercise electrocardiography|exercise ECG]] testing in asymptomatic patients with a low-risk Duke treadmill score. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
|}


Line 29: Line 23:


|-
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' [[Chronic stable angina exercise electrocardiography|Exercise ECG]] testing without an imaging modality in asymptomatic patients with possible [[myocardial ischemia]] on [[Chronic stable angina ambulatory ST segment monitoring|ambulatory ECG]] ([[AECG]]) monitoring or with severe [[coronary calcification]] on [[Chronic stable angina electron beam tomography|EBCT]] in the absence of one of the following [[ECG]] abnormalities:
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Assessment of cardiac structure and function with resting echocardiography may be considered in patients with hypertension or diabetes mellitus and an abnormal ECG. '([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''''<nowiki>"</nowiki>
|-
|-
| bgcolor="LemonChiffon"|'''a.''' Preexcitation ([[Wolff-Parkinson-White syndrome]]) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' Measurement of LV function with radionuclide imaging may be considered in patients with a prior MI or pathological Q waves, provided there is no need to evaluate symptoms or signs suggestive of heart failure, complex ventricular arrhythmias, or an undiagnosed
heart murmur. "([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="LemonChiffon"|'''b.''' Electronically paced ventricular rhythm ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
|}
 
{|class="wikitable"
|-
|-
| bgcolor="LemonChiffon"|'''c.''' More than 1 mm of [[ST depression]] at rest ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
| colspan="1" style="text-align:center; background:Lightcoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]
|-
 
| bgcolor="LemonChiffon"|'''d.''' Complete [[left bundle-branch block]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
| bgcolor="Lightcoral"|<nowiki>"</nowiki>'''1.''' chocardiography, radionuclide imaging, CMR, and cardiac computed tomography are not recommended for routine assessment of LV function in patients with a normal ECG, no history of MI, no symptoms or signs suggestive of heart failure, and no complex ventricular arrhythmias. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' Exercise perfusion imaging or [[Chronic stable angina exercise echocardiography|exercise echocardiography]] in asymptomatic patients with possible [[myocardial ischemia]] on [[Chronic stable angina ambulatory ST segment monitoring|ambulatory ECG]] monitoring or with severe [[coronary calcification]] on [[Chronic stable angina electron beam tomography|EBCT]] who are able to exercise and have one of the following baseline [[ECG]] abnormalities:
|-
| bgcolor="LemonChiffon"|'''a.''' Preexcitation ([[Wolff-Parkinson-White syndrome]]) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
|-
| bgcolor="LemonChiffon"|'''b.''' More than 1 mm of [[ST depression]] at rest. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' [[Adenosine]] or [[dipyridamole]] [[Chronic stable angina perfusion scintigraphy with pharmacologic stress|myocardial perfusion imaging]] in patients with severe [[coronary calcification]] on [[Chronic stable angina electron beam tomography|EBCT]] but with one of the following baseline [[ECG]] abnormalities:
|-
| bgcolor="LemonChiffon"|'''a.''' Electronically paced ventricular rhythm ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
|-
| bgcolor="LemonChiffon"|'''b.''' [[Left bundle-branch block]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.''' [[Adenosine]] or [[dipyridamole]] [[Chronic stable angina perfusion scintigraphy with pharmacologic stress|myocardial perfusion imaging]] or [[dobutamine]] [[echocardiography]] in patients with possible [[myocardial ischemia]] on [[Chronic stable angina ambulatory ST segment monitoring|ambulatory ECG]] monitoring or with [[coronary calcification]] on [[Chronic stable angina electron beam tomography|EBCT]] who are unable to exercise. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''5.''' Exercise [[myocardial perfusion]] imaging or [[Chronic stable angina exercise echocardiography|exercise echocardiography]] after [[Chronic stable angina exercise electrocardiography|exercise ECG]] testing in asymptomatic patients with an intermediate-risk or high-risk Duke treadmill score. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''6.''' [[Adenosine]] or [[dipyridamole]] myocardial perfusion imaging or [[dobutamine]] [[echocardiography]] after [[Chronic stable angina exercise electrocardiography|exercise ECG]] testing in asymptomatic patients with an inadequate [[Chronic stable angina exercise electrocardiography|exercise ECG]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
|}


Revision as of 14:22, 31 October 2016

Chronic stable angina Microchapters

Acute Coronary Syndrome Main Page

Home

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

Landmark Trials

Case Studies

Case #1

Chronic stable angina risk stratification in asymptomatic patients by noninvasive testing On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Chronic stable angina risk stratification in asymptomatic patients by noninvasive testing

CDC onChronic stable angina risk stratification in asymptomatic patients by noninvasive testing

Chronic stable angina risk stratification in asymptomatic patients by noninvasive testing in the news

Blogs on Chronic stable angina risk stratification in asymptomatic patients by noninvasive testing

to Hospitals Treating Chronic stable angina risk stratification in asymptomatic patients by noninvasive testing

Risk calculators and risk factors for Chronic stable angina risk stratification in asymptomatic patients by noninvasive testing

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Smita Kohli, M.D.

ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina (DO NOT EDIT)[1]

Noninvasive Testing for the Diagnosis of Obstructive CAD and Risk Assessment Recommendations(DO NOT EDIT)[1]

Advanced Testing: Resting and Stress Noninvasive Testing

Resting Imaging to Assess Cardiac Structure and Function

Class I
"1. Assessment of resting left ventricular (LV) systolic and diastolic ventricular function and evaluation for abnormalities of myocardium, heart valves, or pericardium are recommended with the use of Doppler echocardiography in patients with known or suspected

IHD and a prior MI, pathological Q waves, symptoms or signs suggestive of heart failure, complex ventricular arrhythmias, or an undiagnosed heart murmur (Level of Evidence: B)"

Class IIb
"1. Assessment of cardiac structure and function with resting echocardiography may be considered in patients with hypertension or diabetes mellitus and an abnormal ECG. '(Level of Evidence: C)'"
"2. Measurement of LV function with radionuclide imaging may be considered in patients with a prior MI or pathological Q waves, provided there is no need to evaluate symptoms or signs suggestive of heart failure, complex ventricular arrhythmias, or an undiagnosed

heart murmur. "(Level of Evidence: C)"

Class III "1. chocardiography, radionuclide imaging, CMR, and cardiac computed tomography are not recommended for routine assessment of LV function in patients with a normal ECG, no history of MI, no symptoms or signs suggestive of heart failure, and no complex ventricular arrhythmias. (Level of Evidence: C)"

References

  1. ↑ 1.0 1.1 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)". J Am Coll Cardiol. 41 (1): 159–68. PMID 12570960.

Template:WikiDoc Sources

Retrieved from "https://www.wikidoc.org/index.php?title=Chronic_stable_angina_risk_stratification_in_asymptomatic_patients_by_noninvasive_testing&oldid=1265272"