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{{Chronic stable angina}}
{{Chronic stable angina}}
'''Editors-In-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:mgibson@perfuse.org] Phone:617-632-7753; {{CZ}}; '''Associate Editor-in-Chief:''' Smita Kohli, M.D.
'''Editors-In-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:mgibson@perfuse.org] Phone:617-632-7753; '''Associate Editor(s)-in-Chief:''' {{CZ}}; Smita Kohli, M.D.; [[Lakshmi Gopalakrishnan]], M.B.B.S.
 
==Overview==
Echocardiography is useful to evaluate ventricular function <ref name="pmid9091535">Cheitlin MD, Alpert JS, Armstrong WF, Aurigemma GP, Beller GA, Bierman FZ et al. (1997) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9091535 ACC/AHA guidelines for the clinical application of echocardiography: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on Clinical Application of Echocardiography). Developed in collaboration with the American Society of Echocardiography.] ''J Am Coll Cardiol'' 29 (4):862-79. PMID: [http://pubmed.gov/9091535 9091535]</ref> and detect [[ischemia]] induced regional wall motion abnormalities that occur at rest, during exercise or with pharmacologic stress testing. Echocardiography is typically useful in patients with murmurs <ref name="pmid10856408">Attenhofer Jost CH, Turina J, Mayer K, Seifert B, Amann FW, Buechi M et al. (2000) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10856408 Echocardiography in the evaluation of systolic murmurs of unknown cause.] ''Am J Med'' 108 (8):614-20. PMID: [http://pubmed.gov/10856408 10856408]</ref>, previous [[MI]] <ref name="pmid11686666">Marchioli R, Avanzini F, Barzi F, Chieffo C, Di Castelnuovo A, Franzosi MG et al. (2001) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11686666 Assessment of absolute risk of death after myocardial infarction by use of multiple-risk-factor assessment equations: GISSI-Prevenzione mortality risk chart.] ''Eur Heart J'' 22 (22):2085-103. [http://dx.doi.org/10.1053/euhj.2000.2544 DOI:10.1053/euhj.2000.2544] PMID: [http://pubmed.gov/11686666 11686666]</ref>, history and ECG changes suggestive of [[Hypertrophic cardiomyopathy diagnostic testing#Echocardiography|hypertrophic cardiomyopathy]] <ref name="pmid11447072">Nagueh SF, Bachinski LL, Meyer D, Hill R, Zoghbi WA, Tam JW et al. (2001) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11447072 Tissue Doppler imaging consistently detects myocardial abnormalities in patients with hypertrophic cardiomyopathy and provides a novel means for an early diagnosis before and independently of hypertrophy.] ''Circulation'' 104 (2):128-30. PMID: [http://pubmed.gov/11447072 11447072]</ref> and in patients with signs and symptoms suggestive of [[Congestive heart failure imaging modalities#heart failure|heart failure]] <ref name="pmid15542421">Fonseca C, Mota T, Morais H, Matias F, Costa C, Oliveira AG et al. (2004) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15542421 The value of the electrocardiogram and chest X-ray for confirming or refuting a suspected diagnosis of heart failure in the community.] ''Eur J Heart Fail'' 6 (6):807-12, 821-2. [http://dx.doi.org/10.1016/j.ejheart.2004.09.004 DOI:10.1016/j.ejheart.2004.09.004] PMID: [http://pubmed.gov/15542421 15542421]</ref>.  


==Transthoracic Echocardiography==
==Transthoracic Echocardiography==
*Echocardiography is useful in the detection of [[ischemia]] induced regional wall motion abnormalities that occur at rest, during exercise or with pharmacologic stress testing.
*Upright treadmill exercise and supine bicycle ergometry, pacing, and pharmacologic stress, particularly with dobutamine, have been used in conjunction with [[two-dimensional echocardiography]] to detect regional wall motion abnormalities that most frequently occur during induced [[myocardial ischemia]] associated with [[CAD]].  
*Upright treadmill exercise and supine bicycle ergometry, pacing, and pharmacologic stress, particularly with dobutamine, have been used in conjunction with [[two-dimensional echocardiography]] to detect regional wall motion abnormalities that most frequently occur during induced [[myocardial ischemia]] associated with [[CAD]].  


Revision as of 22:27, 17 August 2011

Chronic stable angina Microchapters

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Overview

Historical Perspective

Classification

Classic
Chronic Stable Angina
Atypical
Walk through Angina
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Vasospastic Angina

Differentiating Chronic Stable Angina from Acute Coronary Syndromes

Pathophysiology

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Pretest Probability of CAD in a Patient with Angina

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ACC/AHA Guidelines for Alternative Therapies in patients with Refractory Angina

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Risk calculators and risk factors for Chronic stable angina echocardiography

Editors-In-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-632-7753; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Smita Kohli, M.D.; Lakshmi Gopalakrishnan, M.B.B.S.

Overview

Echocardiography is useful to evaluate ventricular function [1] and detect ischemia induced regional wall motion abnormalities that occur at rest, during exercise or with pharmacologic stress testing. Echocardiography is typically useful in patients with murmurs [2], previous MI [3], history and ECG changes suggestive of hypertrophic cardiomyopathy [4] and in patients with signs and symptoms suggestive of heart failure [5].

Transthoracic Echocardiography

  • Upright treadmill exercise and supine bicycle ergometry, pacing, and pharmacologic stress, particularly with dobutamine, have been used in conjunction with two-dimensional echocardiography to detect regional wall motion abnormalities that most frequently occur during induced myocardial ischemia associated with CAD.

ACC / AHA Guidelines- Echocardiography at Rest (DO NOT EDIT)[6]

“

Class I

1. Patients with a systolic murmur suggestive of aortic stenosis and/or hypertrophic cardiomyopathy. (Level of Evidence: C)

2. Evaluation of extent (severity) of ischemia (eg, LV segmental wall motion abnormality) when the echocardiogram can be obtained during pain or within 30 minutes after its abatement. (Level of Evidence: C)

Class IIb

1. Patients with a click and/or murmur to diagnose mitral valve prolapse. (Level of Evidence: C)

Class III

1. Patients with a normal ECG, no history of MI, and no signs or symptoms suggestive of heart failure, valvular heart disease, or hypertrophic cardiomyopathy. (Level of Evidence: C)

”

ESC Guidelines- Echocardiography for initial diagnostic assessment of angina (DO NOT EDIT)[7]

“

Class I

1. Patients with abnormal auscultation suggesting valvular heart disease or hypertrophic cardiomyopathy. (Level of Evidence: B)

2. Patients with suspected heart failure. (Level of Evidence: B)

3. Patients with prior MI. (Level of Evidence: B)

4. Patients with LBBB, Q waves, or other significant pathological changes on ECG, including ECG LVH. (Level of Evidence: C)

”

See Also

Sources

  • Guidelines on the management of stable angina pectoris: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology [7]
  • The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina [6]
  • TheACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina [8]
  • The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina [9]

References

  1. ↑ Cheitlin MD, Alpert JS, Armstrong WF, Aurigemma GP, Beller GA, Bierman FZ et al. (1997) ACC/AHA guidelines for the clinical application of echocardiography: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on Clinical Application of Echocardiography). Developed in collaboration with the American Society of Echocardiography. J Am Coll Cardiol 29 (4):862-79. PMID: 9091535
  2. ↑ Attenhofer Jost CH, Turina J, Mayer K, Seifert B, Amann FW, Buechi M et al. (2000) Echocardiography in the evaluation of systolic murmurs of unknown cause. Am J Med 108 (8):614-20. PMID: 10856408
  3. ↑ Marchioli R, Avanzini F, Barzi F, Chieffo C, Di Castelnuovo A, Franzosi MG et al. (2001) Assessment of absolute risk of death after myocardial infarction by use of multiple-risk-factor assessment equations: GISSI-Prevenzione mortality risk chart. Eur Heart J 22 (22):2085-103. DOI:10.1053/euhj.2000.2544 PMID: 11686666
  4. ↑ Nagueh SF, Bachinski LL, Meyer D, Hill R, Zoghbi WA, Tam JW et al. (2001) Tissue Doppler imaging consistently detects myocardial abnormalities in patients with hypertrophic cardiomyopathy and provides a novel means for an early diagnosis before and independently of hypertrophy. Circulation 104 (2):128-30. PMID: 11447072
  5. ↑ Fonseca C, Mota T, Morais H, Matias F, Costa C, Oliveira AG et al. (2004) The value of the electrocardiogram and chest X-ray for confirming or refuting a suspected diagnosis of heart failure in the community. Eur J Heart Fail 6 (6):807-12, 821-2. DOI:10.1016/j.ejheart.2004.09.004 PMID: 15542421
  6. ↑ 6.0 6.1 Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina). Circulation 99 (21):2829-48. PMID: 10351980
  7. ↑ 7.0 7.1 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.
  8. ↑ Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina). Circulation 107 (1):149-58. PMID: 12515758
  9. ↑ Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007) 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina. Circulation 116 (23):2762-72. DOI:10.1161/CIRCULATIONAHA.107.187930 PMID: 17998462


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