Chronic stable angina ambulatory ST segment monitoring: Difference between revisions
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Ambulatory ECG monitoring (Holter monitor) is used to detect major [[arrhythmias]] and [[myocardial ischemia]] occurring during normal activities. Ambulatory ECG monitoring adds very little prognostic value in patients with chronic stable angina, however, does play a role in the detection of major arrhythmias in patients with chronic stable angina and suspected [[Coronary Vasospasm|vasospastic angina]]. | Ambulatory ECG monitoring (Holter monitor) is used to detect major [[arrhythmias]] and [[myocardial ischemia]] occurring during normal activities. Ambulatory ECG monitoring adds very little prognostic value in patients with chronic stable angina, however, does play a role in the detection of major arrhythmias in patients with chronic stable angina and suspected [[Coronary Vasospasm|vasospastic angina]]. | ||
==Indications== | ==Ambulatory ST Segment Monitoring== | ||
===Indications=== | |||
*Many patients with [[CAD]] experience episodes of asymptomatic [[myocardial ischemia]] detectable by ST segment monitoring whether or not they have [[angina pectoris]]. Patients with symptomatic angina also often have multiple additional episodes of asymptomatic ischemia, and the frequency and severity of these episodes correlate with prognosis. | *Many patients with [[CAD]] experience episodes of asymptomatic [[myocardial ischemia]] detectable by ST segment monitoring whether or not they have [[angina pectoris]]. Patients with symptomatic angina also often have multiple additional episodes of asymptomatic ischemia, and the frequency and severity of these episodes correlate with prognosis. | ||
*In patients with | *In patients with [[Coronary vasospasm|suspected vasospastic angina]] that may not be provoked by effort or by pharmacologic agents such as [[dipyridamole]], [[adenosine]] or [[dobutamine]], ambulatory ST segment monitoring is the preferred test. | ||
*In | *In patients who cannot exercise, ambulatory ST segment monitoring is an alternative. | ||
*[[Chronic stable angina exercise electrocardiography|Exercise electrocardiography]], [[Chronic stable angina perfusion scintigraphy with pharmacologic stress|perfusion scintigraphy with pharmacologic stress]] or with [[Chronic stable angina myocardial perfusion scintigraphy|thallium]] and [[Chronic stable angina echocardiography|echocardiography]] are generally preferable to ambulatory ST segment monitoring in patients with | *[[Chronic stable angina exercise electrocardiography|Exercise electrocardiography]], [[Chronic stable angina perfusion scintigraphy with pharmacologic stress|perfusion scintigraphy with pharmacologic stress]] or with [[Chronic stable angina myocardial perfusion scintigraphy|thallium]] and [[Chronic stable angina echocardiography|echocardiography]] are generally preferable to ambulatory ST segment monitoring in patients with effort angina. | ||
==ESC Guidelines- Ambulatory ECG for | ==ESC Guidelines- Ambulatory ECG for Initial Diagnostic Assessment of Angina (DO NOT EDIT)<ref name="pmid16735367">{{cite journal| author=Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F et al.| title=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. | journal=Eur Heart J | year= 2006 | volume= 27 | issue= 11 | pages= 1341-81 | pmid=16735367 | doi=10.1093/eurheartj/ehl001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16735367 }} </ref>== | ||
===[[European society of cardiology#Classes of Recommendations|Class | {|class="wikitable" | ||
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| colspan="1" style="text-align:center; background:LightGreen"|[[European society of cardiology#Classes of Recommendations|Class I]] | |||
= | |- | ||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' [[Chronic stable angina definition|Angina]] with suspected [[arrhythmia]]. ''([[European society of cardiology#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> | |||
|} | |||
= | {|class="wikitable" | ||
|- | |||
| colspan="1" style="text-align:center; background:LemonChiffon"|[[European society of cardiology#Classes of Recommendations|Class IIa]] | |||
|- | |||
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Suspected [[Chronic stable angina clinical subset- vasospastic angina|vasospastic angina]]. ''([[European society of cardiology#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | |||
|} | |||
==References== | ==References== | ||
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Latest revision as of 14:40, 5 February 2013
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Chronic stable angina Microchapters | ||
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Classification | ||
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Differentiating Chronic Stable Angina from Acute Coronary Syndromes | ||
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Diagnosis | ||
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Alternative Therapies for Refractory Angina | ||
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Discharge Care | ||
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Guidelines for Asymptomatic Patients | ||
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Case Studies | ||
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Chronic stable angina ambulatory ST segment monitoring On the Web | ||
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FDA on Chronic stable angina ambulatory ST segment monitoring | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-632-7753; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Smita Kohli, M.D.; Lakshmi Gopalakrishnan, M.B.B.S.
Overview
Ambulatory ECG monitoring (Holter monitor) is used to detect major arrhythmias and myocardial ischemia occurring during normal activities. Ambulatory ECG monitoring adds very little prognostic value in patients with chronic stable angina, however, does play a role in the detection of major arrhythmias in patients with chronic stable angina and suspected vasospastic angina.
Ambulatory ST Segment Monitoring
Indications
- Many patients with CAD experience episodes of asymptomatic myocardial ischemia detectable by ST segment monitoring whether or not they have angina pectoris. Patients with symptomatic angina also often have multiple additional episodes of asymptomatic ischemia, and the frequency and severity of these episodes correlate with prognosis.
- In patients with suspected vasospastic angina that may not be provoked by effort or by pharmacologic agents such as dipyridamole, adenosine or dobutamine, ambulatory ST segment monitoring is the preferred test.
- In patients who cannot exercise, ambulatory ST segment monitoring is an alternative.
- Exercise electrocardiography, perfusion scintigraphy with pharmacologic stress or with thallium and echocardiography are generally preferable to ambulatory ST segment monitoring in patients with effort angina.
ESC Guidelines- Ambulatory ECG for Initial Diagnostic Assessment of Angina (DO NOT EDIT)[1]
| Class I |
| "1. Angina with suspected arrhythmia. (Level of Evidence: B)" |
| Class IIa |
| "1. Suspected vasospastic angina. (Level of Evidence: C)" |
References
- ↑ 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.