Chronic stable angina risk stratification electrocardiogram/chest x-ray: Difference between revisions
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*Rest [[ECG]] abnormalities that are associated with poor outcomes include: | *Rest [[ECG]] abnormalities that are associated with poor outcomes include: | ||
:*Left ventricular hypertrophy ([[LVH]]) by ECG criteria, | :*Left ventricular hypertrophy ([[LVH]]) by ECG criteria, | ||
:*Persistent ST-T wave inversions in V1-V3, <ref name="pmid6105556"> (1980) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=6105556 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: [http://pubmed.gov/6105556 6105556]</ref> <ref name="pmid331107">Murphy ML, Hultgren HN, Detre K, Thomsen J, Takaro T (1977) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=331107 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. [http://dx.doi.org/10.1056/NEJM197709222971201DOI:10.1056/NEJM197709222971201] PMID: [http://pubmed.gov/331107 331107]</ref> <ref name="pmid4632503">Frank CW, Weinblatt E, Shapiro S (1973)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=4632503 Angina pectoris in men. Prognostic significance of selected medical factors.] ''Circulation'' 47 (3):509-17. PMID: [http://pubmed.gov/4632503 4632503]</ref> | :*Persistent ST-T wave inversions in V1-V3,<ref name="pmid6105556"> (1980) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=6105556 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: [http://pubmed.gov/6105556 6105556]</ref><ref name="pmid331107">Murphy ML, Hultgren HN, Detre K, Thomsen J, Takaro T (1977) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=331107 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. [http://dx.doi.org/10.1056/NEJM197709222971201DOI:10.1056/NEJM197709222971201] PMID: [http://pubmed.gov/331107 331107]</ref><ref name="pmid4632503">Frank CW, Weinblatt E, Shapiro S (1973)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=4632503 Angina pectoris in men. Prognostic significance of selected medical factors.] ''Circulation'' 47 (3):509-17. PMID: [http://pubmed.gov/4632503 4632503]</ref> | ||
:*[[Q waves]] in multiple leads, | :*[[Q waves]] in multiple leads, | ||
:*[[R wave]] in V1 (a | :*[[R wave]] in V1 (a posterior 'q wave'),<ref name="pmid14955434">BLOCK WJ, CRUMPACKER EL, DRY TJ, GAGE RP (1952)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=14955434 Prognosis of angina pectoris; observations in 6,882 cases.] ''J Am Med Assoc'' 150 (4):259-64. PMID: [http://pubmed.gov/14955434 14955434]</ref> | ||
:*[[Bundle branch block]]s and atrial, or | :*[[Bundle branch block]]s and atrial, or | ||
:*Ventricular [[arrythmias]] <ref name="pmid7371129">Ruberman W, Weinblatt E, Goldberg JD, Frank CW, Shapiro S, Chaudhary BS (1980)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7371129 Ventricular premature complexes in prognosis of angina.] ''Circulation'' 61 (6):1172-82. PMID: [http://pubmed.gov/7371129 7371129]</ref>. | :*Ventricular [[arrythmias]]<ref name="pmid7371129">Ruberman W, Weinblatt E, Goldberg JD, Frank CW, Shapiro S, Chaudhary BS (1980)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7371129 Ventricular premature complexes in prognosis of angina.] ''Circulation'' 61 (6):1172-82. PMID: [http://pubmed.gov/7371129 7371129]</ref>. | ||
==Chest X- | ==Chest X-Ray== | ||
The presence of [[cardiomegaly]] or pulmonary vascular congestion on chest X-ray is also associated with a poor prognosis. | 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) <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>== | ==ESC Guidelines- Clinical Evaluation and ECG for Risk Stratification (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>== | ||
'''2.''' Resting [[ECG]] in all patients. ''([[European society of cardiology#Level of Evidence|Level of Evidence: B]])'' | {|class="wikitable" | ||
|- | |||
| colspan="1" style="text-align:center; background:LightGreen"|[[European society of cardiology#Classes of Recommendations|Class I]] | |||
|- | |||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Detailed [[Chronic stable angina symptoms|clinical history]] and [[Physical examination|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. ''([[European society of cardiology#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> | |||
|- | |||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Resting [[ECG]] in all patients. ''([[European society of cardiology#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> | |||
|} | |||
==References== | ==References== | ||
Latest revision as of 16:36, 29 January 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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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [3]; 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:
- Left ventricular hypertrophy (LVH) by ECG criteria,
- Persistent ST-T wave inversions in V1-V3,[2][3][4]
- Q waves in multiple leads,
- R wave in V1 (a posterior 'q wave'),[5]
- Bundle branch blocks and atrial, or
- Ventricular arrythmias[6].
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)" |
References
- ↑ 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
- ↑ (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
- ↑ 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
- ↑ Frank CW, Weinblatt E, Shapiro S (1973)Angina pectoris in men. Prognostic significance of selected medical factors. Circulation 47 (3):509-17. PMID: 4632503
- ↑ 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
- ↑ 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
- ↑ 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.