Chronic stable angina echocardiography
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Chronic stable angina Microchapters | ||
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Classification | ||
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Differentiating Chronic Stable Angina from Acute Coronary Syndromes | ||
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Diagnosis | ||
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Alternative Therapies for Refractory Angina | ||
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Discharge Care | ||
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Guidelines for Asymptomatic Patients | ||
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Case Studies | ||
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Chronic stable angina echocardiography On the Web | ||
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to Hospitals Treating Chronic stable angina echocardiography | ||
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Risk calculators and risk factors for Chronic stable angina echocardiography | ||
Editors-In-Chief: C. Michael Gibson, M.S., M.D. [4] Phone:617-632-7753; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [5]; 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 abnormality that occurs at rest, during exercise or with pharmacologic stress test. As a testing modality, two-dimensional echocardiography is often coupled with other testing modalities to detect regional wall motion abnormalities that most frequently occur during induced myocardial ischemia associated with coronary artery disease (CAD). Potential paired testing modalities include: upright treadmill exercise, supine bicycle ergometry, pacing, and pharmacologic stress, particularly with dobutamine. Patients with CAD may respond more adversely to testing modalities than their counterparts. Often, an adverse outcome such as the inability to perform a bicycle ergometry test or exercise treadmill protocol can be characterized as a poor prognostic factor.
Indications
- Echocardiography is typically useful in patients with murmurs,[2] previous MI[3] history and ECG changes suggestive of hypertrophic cardiomyopathy.[4]
- Regardless of the etiology, diastolic dysfunction has a major impact on the functional status, treatment and prognosis of heart failure.
- There is also an independent association observed between diastolic heart failure and history of ischemic heart disease, further emphasizing the use of echocardiography in patients with signs and symptoms suggestive of heart failure.[5][6]
- Resting echocardiography, doppler imaging and strain rate measurement[7] have improved the ability to identify undetected diastolic dysfunction[8] in chronic stable angina patients without heart failure.
ACC / AHA Guidelines- Echocardiography at Rest (DO NOT EDIT) [9]
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Class I1. Patients with a systolic murmur suggestive of aortic stenosis and/or hypertrophic cardiomyopathy. (Level of Evidence: C) 2. Evaluation of extent (severity) of ischemia (e.g., left ventroicular segmental wall motion abnormality) when the echocardiogram can be obtained during pain or within 30 minutes after its abatement. (Level of Evidence: C) Class IIb1. Patients with a click and/or murmur to diagnose mitral valve prolapse. (Level of Evidence: C) Class III1. 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) |
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ESC Guidelines- Echocardiography for initial diagnostic assessment of angina (DO NOT EDIT) [10]
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Class I1. 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 criteria for LVH. (Level of Evidence: C) |
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Vote on and Suggest Revisions to the Current Guidelines
Guidelines Resources
- The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina [9]
- Guidelines on the management of stable angina pectoris: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology [10]
- The ACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina [11]
- The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina [12]
References
- ↑ 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
- ↑ 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
- ↑ 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
- ↑ 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
- ↑ O'Mahony MS, Sim MF, Ho SF, Steward JA, Buchalter M, Burr M (2003)Diastolic heart failure in older people. Age Ageing 32 (5):519-24. PMID: [1]
- ↑ 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
- ↑ Yip G, Abraham T, Belohlavek M, Khandheria BK (2003) Clinical applications of strain rate imaging. J Am Soc Echocardiogr 16 (12):1334-42. DOI:10.1067/j.echo.2003.09.004 PMID: 14652617
- ↑ Beattie RC, Spence J (1991) Auditory brainstem response to clicks in quiet, notch noise, and highpass noise. J Am Acad Audiol 2 (2):76-90. PMID: 1768877
- ↑ 9.0 9.1 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
- ↑ 10.0 10.1 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.
- ↑ 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.[2] PMID: 12515758
- ↑ 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.[3] PMID: 17998462