Diagnostic tests for coronary artery diseases resident survival guide
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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 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||