Chest pain other diagnostic studies

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Aisha Adigun, B.Sc., M.D.[3]

Overview

Invasive Coronary Angiography (ICA) is used to determine the presence and severity of a luminal obstruction of an epicardial coronary artery, including its location, length, and diameter, as well as coronary blood flow. ICA provides the characterization of high-grade obstructive stenosis and possibility for percutaneous or surgical revascularization. (IFR and FFR) provide physiologic characteristic of stenosis. Radiation exposure to the patient during an interventional procedure varied 4 to 10 mSv and is dependent on procedural duration and complexity. The spatial resolution of ICA is 0.3 mm; as such, it is impossible to visualize arterioles (diameter of 0.1 mm) that regulate myocardial blood flow. Coronary vascular functional studies can be performed during coronary angiography. In normal coronary angiography there may be evident abnormal coronary vascular function. Assessment of coronary microcirculation and coronary vasomotion by coronary function testing are reasonable.

Other Diagnostic Studies

• Invasive Coronary Angiography (ICA) is used to determine the presence and severity of a luminal obstruction of an epicardial coronary artery, including its location, length, and diameter, as well as coronary blood flow.
• ICA provides the characterization of high-grade obstructive stenosis and the possibility for percutaneous or surgical revascularization.
• (IFR and FFR) provide physiologic characteristic of stenosis.
• Radiation exposure to the patient during an interventional procedure varied 4 to 10 mSv and is dependent on procedural duration and complexity.
• The spatial resolution of ICA is 0.3 mm; as such, it is impossible to visualize arterioles (diameter of 0.1 mm) that regulate myocardial blood flow.
• Coronary vascular functional studies can be performed during coronary angiography.
• In normal coronary angiography there may be evidence of abnormal coronary vascular function.
• Assessment of coronary microcirculation and coronary vasomotion by coronary function testing are reasonable.

Contraindications of stress test for diagnosis of acute chest pain

Exercise ECG	Stress Nuclear	400px	500px	600px
Abnormal ST changes on resting ECG, digoxin, left bundle branch block, Wolff-Parkinson-White pattern, ventricular paced rhythm (unless test is performed to establish exercise capacity and not for diagnosis of ischemia)	High-risk unstable angina, complicated ACS or AMI (<2 d)	The width of this column is 400px	The width of this column is 500px	The width of this column is 600px
Unable to achieve ≥5 METs or unsafe to exercise High-risk unstable angina or AMI (<2 days), ative ACS, Uncontrolled heart failure	Contraindications to vasodilator administration	The width of this column is 400px	The width of this column is 500px	The width of this column is 600px
Significant cardiac arrhythmias (VT, complete atrioventricular block) or high risk for arrhythmias caused by QT prolongation	Significant arrhythmias (VT, second- or third-degree atrioventricular block) or sinus bradycardia <45 bpm	The width of this column is 400px	The width of this column is 500px	The width of this column is 600px
Severe symptomatic aortic stenosis	Significant hypotension (SBP <90 mm Hg)	The width of this column is 400px	The width of this column is 500px	The width of this column is 600px
Severe systemic arterial hypertension≥200/110 mmHg	Known or suspected bronchoconstriction or bronchospastic disease	The width of this column is 400px	The width of this column is 500px	The width of this column is 600px
Acute illness ( acute pulmonary embolism, acute myocarditis, acute pericarditis, acute aortic dissection	Recent use of dipyridamole or dipyridamole containing medications Use of methylxanthines ( aminophylline, caffeine) within 12 h Known hypersensitivity to adenosine, regadenoson Severe systemic arterial hypertension (≥200/110 mm Hg)	The width of this column is 400px	The width of this column is 500px	The width of this column is 600px