Diagnostic tests for coronary artery diseases resident survival guide: Difference between revisions
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{{CMG}}; '''Associate Editor-In-Chief:'''; [[Priyamvada Singh|Priyamvada Singh, M.D.]] [mailto:psingh13579@gmail.com] | {{CMG}}; '''Associate Editor-In-Chief:'''; [[Priyamvada Singh|Priyamvada Singh, M.D.]] [mailto:psingh13579@gmail.com] | ||
== | ==Overview== | ||
==Causes== | ==Causes== | ||
===Life Threatening Causes=== | ===Life Threatening Causes=== | ||
===Common Causes=== | ===Common Causes=== | ||
==Management== | ==Management== | ||
===Exercise stress testing=== | |||
{| class="wikitable sortable" | {| class="wikitable sortable" | ||
!Test | !Test | ||
Line 12: | Line 14: | ||
!Disadvantages | !Disadvantages | ||
|- | |- | ||
|Exercise EKG ||Initial test for suspected [[CAD]]|| Information regarding functional capacity, <br> and hemodynamic changes to exercise || Contraindicated with baseline EKG abnormalities i.e. [[LVH]] , <br> [[LBBB]], > 1mm ST depression, [[WPW]], [[paced rhythm]] | |'''Exercise EKG''' ||Initial test for suspected [[CAD]]|| Information regarding functional capacity, <br> and hemodynamic changes to exercise || Contraindicated with baseline EKG abnormalities i.e. [[LVH]] , <br> [[LBBB]], > 1mm ST depression, [[WPW]], [[paced rhythm]] | ||
|- | |- | ||
|Stress ECHO ||a) With baseline EKG abnormality <br> b) Information | |'''Stress ECHO''' ||a) With baseline EKG abnormality <br> b) Information on an area of myocardium at risk is needed|| a) Information regarding exercise data, <br> wall motion abnormality, valvular defects, and pulmonary pressures <br> b) portable, cheap, fast|| Image quality, and interpretation difficult <br> with baseline wall motion abnormality, <br> decreased accuracy in single vessel disease, <br> or delayed images | ||
|- | |- | ||
|'''Nuclear SPECT perfusion''' ||a) With baseline EKG abnormality <br> b) Information on an area of myocardium at risk is needed|| a) Technetium has superior images compared <br> to thallium but has longer half life. For superior images technetium is used|| Artifacts caused by diaphragm, or breast tissue <br> Radiation exposure | |||
|} | |} | ||
===Pharmacological stress testing=== | |||
{| class="wikitable sortable" | |||
!Test | |||
!Indications | |||
!Advantages | |||
!Disadvantages | |||
|- | |||
|'''Dobutamine echocardiography''' ||a) Done in patients who can't exercise <br> b) Information on an area of myocardium at risk is needed||Image qualities comparable to [[echocardiography]]||a) [[Hypertension]] <br> b) [[Arrhythmia]]<br> c) [[Beta blocker]] should be held prior to test | |||
|- | |||
|'''Dobutamine nuclear <br> perfusion''' ||a) Done in patients who can't exercise <br> b) Information on an area of myocardium at risk is needed|| a) Information regarding exercise data, <br> wall motion abnormality, valvular defects, and pulmonary pressures <br> b) portable, cheap, fast|| a)[[Hypertension]] <br> b) [[Arrhythmia]]<br> c) [[Beta blocker]] should be held prior to test <br> Radiation exposure | |||
|- | |||
|'''Vasodilator nuclear <br> perfusion''' ||a) Done in patients who can't exercise & have <br> contraindications to [[dobutamine]]|| a) Technetium has superior images compared <br> to thallium but has longer half life. For superior images technetium is used|| Artifacts caused by diaphragm, or breast tissue <br> Radiation exposure | |||
|} | |||
==Management== | |||
Shown below is an algorithm summarizing the approach to <nowiki>[[disease name]]</nowiki>. | |||
{{familytree/start |summary= Diagnostic tests for CAD Algorithm}} | |||
{{familytree | | | | | | | | | | | | | | | | | A01 | | | | | | | | | | | | | | | | | |A01 = '''Symptoms of [[Coronary artery disease]]'''}} | |||
{{familytree | | | | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | |}} | |||
{{familytree | | | | | | | | | | | | | | | | | B01 | | | | | | | | | | | | | | | | | | | | | | | | | |B01=Pretest probability of [[CAD]]}} | |||
{{familytree | | | | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | |}} | |||
{{familytree | | | | | |,|-|-|-|-|-|-|-|-|-|-|-|+|-|-|-|-|-|-|-|-|-|-|-|.| | | | | | | | | | | | | | | | | | | | | | | }} | |||
{{familytree | | | | | |!| | | | | | | | | | | |!| | | | | | | | | | | |!| | | | | | | | | | | | | | | |}} | |||
{{familytree | | | | | C01 | | | | | | | | | | C02 | | | | | | | | | | C03 | | | | | | | | | | | | | | | | | | |C01= '''Low'''|C02= '''Intermediate'''|C03='''High'''}} | |||
{{familytree | | | | | |!| | | | | | | | | | | |!| | | | | | | | | | | |!| | | | | | | | | | | | | | | |}} | |||
{{familytree | | | | | D01 | | | | | | | | | | D02 | | | | | | | | | | D03 | | | | | | | | | | | | | | | | | | |D01= No other test required|D02= EKG normal, patient can exercise|D03=Start medical therapy for CAD}} | |||
{{familytree | | | | | | | | | | | | | | | | | |!| | | | | | | | | | | |!| | | | | | | | | | |}} | |||
{{familytree | | | | | | | | | | | | | | | | | E01 | | | | | | | | | | E02 | | | | | | | | | | | | | | | | | |E01= '''Exercise treadmill stress test''' |E02= '''Failure to medical management, <br> lifestyle compromising symptoms, <br> progress to [[unstable angina]] }} | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Resident survival guide]] | [[Category:Resident survival guide]] | ||
Latest revision as of 11:40, 13 March 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief:; Priyamvada Singh, M.D. [2]
Overview
Causes
Life Threatening Causes
Common Causes
Management
Exercise stress testing
Test | Indications | Advantages | Disadvantages |
---|---|---|---|
Exercise EKG | Initial test for suspected CAD | Information regarding functional capacity, and hemodynamic changes to exercise |
Contraindicated with baseline EKG abnormalities i.e. LVH , LBBB, > 1mm ST depression, WPW, paced rhythm |
Stress ECHO | a) With baseline EKG abnormality b) Information on an area of myocardium at risk is needed |
a) Information regarding exercise data, wall motion abnormality, valvular defects, and pulmonary pressures b) portable, cheap, fast |
Image quality, and interpretation difficult with baseline wall motion abnormality, decreased accuracy in single vessel disease, or delayed images |
Nuclear SPECT perfusion | a) With baseline EKG abnormality b) Information on an area of myocardium at risk is needed |
a) Technetium has superior images compared to thallium but has longer half life. For superior images technetium is used |
Artifacts caused by diaphragm, or breast tissue Radiation exposure |
Pharmacological stress testing
Test | Indications | Advantages | Disadvantages |
---|---|---|---|
Dobutamine echocardiography | a) Done in patients who can't exercise b) Information on an area of myocardium at risk is needed |
Image qualities comparable to echocardiography | a) Hypertension b) Arrhythmia c) Beta blocker should be held prior to test |
Dobutamine nuclear perfusion |
a) Done in patients who can't exercise b) Information on an area of myocardium at risk is needed |
a) Information regarding exercise data, wall motion abnormality, valvular defects, and pulmonary pressures b) portable, cheap, fast |
a)Hypertension b) Arrhythmia c) Beta blocker should be held prior to test Radiation exposure |
Vasodilator nuclear perfusion |
a) Done in patients who can't exercise & have contraindications to dobutamine |
a) Technetium has superior images compared to thallium but has longer half life. For superior images technetium is used |
Artifacts caused by diaphragm, or breast tissue Radiation exposure |
Management
Shown below is an algorithm summarizing the approach to [[disease name]].
References
Symptoms of Coronary artery disease | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pretest probability of CAD | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Low | Intermediate | High | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
No other test required | EKG normal, patient can exercise | Start medical therapy for CAD | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Exercise treadmill stress test | Failure to medical management, lifestyle compromising symptoms, progress to unstable angina | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||