Chronic stable angina test selection guideline for the individual basis

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Editor-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.

Overview

Criteria for test selection hinges largely on the current disease state of the individual patient and subsequent level of fitness for testing. Potential diagnostic testing modalities include: exercise ECG, ECG at rest, exercise echocardiography, echocardiography at rest, and stress scintigraphy.

Test Selection Guidelines for the Individual Basis

  • Even when the exercise ECG is not deemed clinically necessary to establish the diagnosis of coronary artery disease (CAD), it can be helpful in assessing CAD severity.
  • If evidence for ischemia (by ECG or by perfusion scintigraphy or echocardiography) is detected during the first stage of exercise, the incidence of three-vessel disease or left main coronary artery stenosis is greater than compared to cases more exercise is required to provoke a positive test.
  • Exercise electrocardiography in patients with suspected or established stable angina pectoris can be a useful tool in determining usage of nonpharmacologic and pharmacologic therapeutic interventions.
  • The diagnosis of metabolic syndrome is established by the presence of typical anginal discomfort that is accompanied by ischemic changes on exercise ECG (or exercise or stress scintigraphy) with subsequent demonstration of the absence of critical coronary artery obstruction on coronary arteriography.
  • In women with typical angina, exercise ECG can be an adequate testing means. However, due to a higher incidence of false positive test results in stress ECG in women, exercise perfusion scintigraphy or exercise echocardiography should also be considered as a reasonable testing alternative, often with fewer specificity issues.

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