Journal List > J Korean Med Assoc > v.47(8) > 1080424

Hong: Diagnosis of Coronary Artery Disease

Abstract

The routine evaluation of coronary artery disease should include a history that obtains data on the charactor of pain, age, associated symptoms, and past history. The physical examination should include vital signs, a cardiovascular and pulmonary examination. The initial resting ECG plays a central role. Exercise ECG is an appropriate first-line test for patients with an intermediate probability of coronary artery disease. Echocardiogram is as a routine test for diagnosis of the case of acute chest pain especially in patients with a systolic murmur or regional wall motion almormality. Imaging during physical or pharmacological stress is considered to be appropriate in patients for whom exercise ECG is unlikely to be useful because of baseline ECG abnormalities. Pharmacological stress with adenosine or dipyridamole is appropriate for patients who are unable to exercise. Coronary angiography is not considered clearly appropriate as routine test for diagnosis of chronic stable angina in most patients except for those who had survived sudden cardiac death. But it is considered appropriate for diagnosis of angina whose diagonsis is still uncertain after noninsasive testing. Cardiac troponin is as a preferred marker for acute ischemic injury. Biochemical cardiac markers should be performed for all patients with suspected acute myocardial infarction.

Figures and Tables

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References

1. Gibbons RJ, Chatterjee K, Daley J, et al. ACC/AHA/ACP-ASIM guidelines for management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 1999. 33:2092–2197. {Erratum J Am coll Cardiol 1999 ; 34 : 314}.
2. Cohn PF, Fox KM. Silent myocardial ischemia. Circulation. 2003. 108:1263–1277.
crossref
3. Gibbons RJ, Balady GJ, Bricker JT, et al. ACC/AHA 2002 Guideline Update for Exercise Testing : Summary Article. A report of the American College of Cardilogy/American Heart Association Task Force on Practice Guidelines(Committee to Update the 1997 Exercise Testing Guidelines). J Am Coll Cardiol. 2002. 40:1531–1540.
4. Mark DB, Shaw L, Harrell FE Jr, et al. Prognostic value of a treadmill exercise score in outpatients with suspected coronary arterial disease. N Engl J Med. 1991. 325:849–853.
crossref
5. Klocke FJ, Baird MG, Lorell BH, et al. ACC/AHA/ASNC Guidelines for the Clinical Use of Cardiac Radionuclide Ima-ging : Executive Summary. A report of the American College of Cardilogy/American Heart Association Task Force on Practice Guidelines(ACC/AHA/ASNC Committee to Revise the 1995 Guidelines for the Clinical Use of Cardiac Radionuclide Imaging). J Am Coll Cardiol. 2003. 42:1318–1333.
6. Cheitlin MD, Armstrong WF, Aurigemma GP, et al. ACC/AHA/ASE 2003 Guideline Update for the Clinical Application of Echocardiography : Summary Article. A report of the American College of Cardilogy/American Heart Association Task Force on Practice Guidelines. Circulation. 2003. 108:1146–1162.
crossref
7. Jenkins CD. Recent evidence supporting psychologic and social risk factors for coronary disease. N Engl J Med. 1976. 294:1033–1038.
crossref
8. Feng DL, Tofler GH. Diurnal physiologic processes and circadian variation of acute myocardial infarction. J Cardiovasc Risk. 1995. 2:494–498.
crossref
9. Mitler MM, Kripke DF. Circadian variation in myocardial infarction. N Engl J Med. 1986. 314:1187–1188.
crossref
10. Killip T, Kimball JT. Treatment of myocardial infarction in a coronary care unit: A two year experience with 250 patients. Am J Cardiol. 1967. 20:457–464.
11. Spodick DH. Francis GS, Alpert JS, editors. Pericardial complications of myocardial infarction. Coronary Care. 1995. Boston, Little: Brown & Co;333–341.
12. Goldman L, Cook EF, Brand DA, Lee TH, Rouan GW, Weisberg MC. A computer protocol to predict myocardial infarction in emergency department patients with chest pain. N Engl J Med. 1988. 318:797–803.
crossref
13. Bayes de Luna A. Clinical Electrocardiography : A Textbook. 1998. Armonk, NY: Futura Publishing.
14. Panju AA, Hemmelgarn BR, Guyatt GH, Simel DL. Is this patient having a myocardial infarction? JAMA. 1998. 280:1256–1263.
crossref
15. Hathaway WR, Peterson ED, Wagner GS. Prognostic significance of the initial electrocardiogram in patients with acute myocardial infarction GUSTOI Investigators Global Utilization of Streptokinase and tPA for Occluded Coronary Arteries. JAMA. 1998. 279:387–391.
crossref
16. Holmvang L, Clemmensen P, Wagner G, Grande P. Admission standard electrocardiogram for early risk stratification in patients with unstable coronary artery disease not eligible for acute revascularization therapy: A TRIM substudy. Thrombin Inhibition in Myocardial Infarction. Am Heart J. 1999. 137:24–33.
crossref
17. Rude RE, Poole WK, Muller JE, Turi Z, Rutherford J, Parker C. Electrocardiographic and clinical criteria for recognition of acute myocardial infraction based on analysis of 3,467 patients. Am J Cardiol. 1983. 52:936–942.
18. Pedoe-Tunstall H, Kuulasmaa K, Amouyel P. Myocardial infarction and coronary deaths in the World Health Organization MONICA Project. Circulation. 1994. 90:583–612.
crossref
19. Fox AC, Levin RI. Ruptured plaques and leaking cells: Cost-effectiveness in the diagnosis of acute coronary syndromes. Ann Intern Med. 1999. 131:968–970.
crossref
20. Mair J, Dienstl F, Puschendorf B. Cardiac troponin T in the diagnosis of myocardial injury. Crit Rev Clin Lab Sci. 1992. 29:31–57.
crossref
21. Cheitlin MD, Alpert JS, Armstrong WF. ACC/AHA guidelines for the clinical application of echocardiography. J Am Coll Cardiol. 1997. 29:862–879.
22. Schwaiger M, Melin J. Cardiological application of nuclear medicine. Lancet. 1999. 354:661–666.
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