Diagnostic tests for coronary artery diseases resident survival guide: Difference between revisions
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{{familytree | | | | | C01 | | | | | | | | | | C02 | | | | | | | | | | C03 | | | | | | | | | | | | | | | | | | |C01= '''Low'''|C02= '''Intermediate'''|C03='''High'''}} | {{familytree | | | | | C01 | | | | | | | | | | C02 | | | | | | | | | | C03 | | | | | | | | | | | | | | | | | | |C01= '''Low'''|C02= '''Intermediate'''|C03='''High'''}} | ||
{{familytree | | | | | |!| | | | | | | | | | | |!| | | | | | | | | | | |!| | | | | | | | | | | | | | | |}} | {{familytree | | | | | |!| | | | | | | | | | | |!| | | | | | | | | | | |!| | | | | | | | | | | | | | | |}} | ||
{{familytree | | | | | D01 | | | | | | | | | | D02 | | | | | | | | | | D03 | | | | | | | | | | | | | | | | | | |C01= | {{familytree | | | | | D01 | | | | | | | | | | D02 | | | | | | | | | | D03 | | | | | | | | | | | | | | | | | | |C01= No other test required|C02= EKG normal, patient can exercise|C03=Start medical therapy for CAD}} |
Revision as of 17:15, 9 December 2013
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief:; Priyamvada Singh, M.D. [2]
Definition
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]].
Symptoms of Coronary artery disease | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pretest probability of CAD | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Low | Intermediate | High | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
{{{ D01 }}} | {{{ D02 }}} | {{{ D03 }}} | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||