Document Detail


Guidelines for the management of patients with chronic stable angina: diagnosis and risk stratification.
MedLine Citation:
PMID:  11578158     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Patients with suspected chronic stable angina can be evaluated in three stages. In stage one, the clinician uses information from the history, physical examination, laboratory tests for diabetes and hyperlipidemia, and resting electrocardiography to estimate the patient's probability of coronary artery disease (CAD). In stage two, additional testing for patients with a low probability of CAD focuses on diagnosing noncoronary causes of chest pain. Patients with a high probability of CAD have stress tests to assess their risk from CAD, and patients with an intermediate probability of CAD have stress tests to estimate the probability of CAD and assess their risk from CAD. Most patients with new-onset angina can start stress testing with exercise electrocardiography. The initial stress test should be a stress imaging procedure for patients with rest ST-segment depression greater than 1 mm, complete left bundle-branch block, ventricular paced rhythm, preexcitation syndrome, or previous revascularization with percutaneous coronary angioplasty or coronary artery bypass grafting. Patients who cannot exercise can have an imaging procedure with stress induced by pharmacologic agents. In stage three, patients with a predicted average annual cardiac mortality rate between 1% and 3% should have a stress imaging study or coronary angiography with left ventriculography. Those with a known left ventricular dysfunction should have cardiac catheterization. Patients with CAD who have an estimated annual mortality rate greater than 3% should have cardiac catheterization to determine whether their anatomy is suitable for revascularization. Patients with an estimated annual mortality rate less than 1% can begin to receive medical therapy.
Authors:
S V Williams; S D Fihn; R J Gibbons; ; ;
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Publication Detail:
Type:  Guideline; Journal Article; Practice Guideline    
Journal Detail:
Title:  Annals of internal medicine     Volume:  135     ISSN:  0003-4819     ISO Abbreviation:  Ann. Intern. Med.     Publication Date:  2001 Oct 
Date Detail:
Created Date:  2001-10-01     Completed Date:  2001-10-18     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0372351     Medline TA:  Ann Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  530-47     Citation Subset:  AIM; IM    
Affiliation:
Division of General Internal Medicine, 1220 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021, USA. sankey@wharton.upenn.edu
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MeSH Terms
Descriptor/Qualifier:
Algorithms
Angina Pectoris / diagnosis,  etiology*
Angiography / methods
Comorbidity
Coronary Angiography
Coronary Disease / complications,  diagnosis*
Echocardiography
Electrocardiography
Exercise Test
Female
Humans
Male
Radionuclide Ventriculography
Risk Assessment
Comments/Corrections
Comment In:
Ann Intern Med. 2001 Oct 2;135(7):527-9   [PMID:  11578157 ]
Erratum In:
Ann Intern Med 2992 Jan 15;136(2):175

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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