How would you investigate a patient with angina pectoris ?
• Haemoglobin: anaemia aggravates angina.
• Rest ECG: to detect left ventricular hypertrophy, prior Q-wave MI or ST-T changes.
• Rest echocardiogram: done only when there is clinical suspicion of aortic stenosis or hypertrophic
cardiomyopathy.
• Exercise ECG: to precipitate symptoms, to document workload at onset and to record any
associated ECG abnormality (?> I mm of horizontal or downsloping ST-segment depression or
elevation for ?> 60 to 80 ms after the end of the QRS complex) or arrhythmia.
• Exercise myocardial perfusion imaging or exercise echocardiography in patients who have one of
the following baseline ECG abnormalities: (a) LBBB, (b) more than 1 mm of rest ST depression, (c)
electronically paced ventricular rhythm, and in patients with prior revascularization (PTCA or CABG)
or in whom consider-ations of functional significance of lesions or myocardial viability are important.
• Coronary angiography: provides detailed anatomical in/ormation about site and severity of luminal
narrowing due to coronary atherosclerosis and less common non-atherosclerotic causes such as
coronary artery spasm, coronary anomaly, primary coronary artery dissection and radiation-induced
coronary vasculopathy.
Lexo edhe:
• Haemoglobin: anaemia aggravates angina.
• Rest ECG: to detect left ventricular hypertrophy, prior Q-wave MI or ST-T changes.
• Rest echocardiogram: done only when there is clinical suspicion of aortic stenosis or hypertrophic
cardiomyopathy.
• Exercise ECG: to precipitate symptoms, to document workload at onset and to record any
associated ECG abnormality (?> I mm of horizontal or downsloping ST-segment depression or
elevation for ?> 60 to 80 ms after the end of the QRS complex) or arrhythmia.
• Exercise myocardial perfusion imaging or exercise echocardiography in patients who have one of
the following baseline ECG abnormalities: (a) LBBB, (b) more than 1 mm of rest ST depression, (c)
electronically paced ventricular rhythm, and in patients with prior revascularization (PTCA or CABG)
or in whom consider-ations of functional significance of lesions or myocardial viability are important.
• Coronary angiography: provides detailed anatomical in/ormation about site and severity of luminal
narrowing due to coronary atherosclerosis and less common non-atherosclerotic causes such as
coronary artery spasm, coronary anomaly, primary coronary artery dissection and radiation-induced
coronary vasculopathy.
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Lexo edhe:
