Angina is most commonly associated with myocardial ischemia, but may also be symptomatic of valvular heart disease, hypertrophic cardiomyopathy or uncontrolled high blood pressure. While chronic or stable angina is predictable and relatively easy to manage, it is the sudden and unexpected onset of symptoms in patients with unstable angina that represents the most significant challenge to the clinician, being a risk indicator for acute MI, severe cardiac arrhythmia or even cardiac arrest. Since chest pain can also indicate a number of other less critical conditions, it is important that the clinician can rapidly and accurately determine the true risk status of the patient in each case. In this atlas, the authors guide the reader through the assessment of the patient with chest pain, beginning with the simple physical examination and evaluation of other risk factors that may be present, progressing to non-invasive tests such as EKG and various imaging techniques, and concluding with coronary angiography. The diagnostic value of each of these techniques is compared and appropriate guidance given on evaluating clinical findings.
Preface; Abbreviations; 1. Angina pectoris: epidemiology, natural history, and pathophysiology; 2. Angina pectoris: clinical evaluation; * characteristics of angina/grading; * differential diagnosis; * physical examination; Case scenario; 3. Noninvasive detection of coronary artery disease; * biochemical tests; * resting EKG and exercise EKG; * myocardial perfusion imaging: exercise & pharmacologic stress; * exercise radionuclide ventriculography; * echocardiography: exercise & pharmacologic stress; * MCE, EBCT, MSCT, MRI; * clinical application: limitations, gender differences, high risk profiles; 4. Coronary angiography and ancillary techniques for the invasive assessment of angina pectoris; * indications and objectives; * interpretation and complications; * limitations; 5. Nonatherosclerotic causes of angina pectoris and ischemia; * Prinzmetal's/variant angina; * chest pain with normal coronary angiography; * silent myocardial ischemia; 6. An approach to management of chronic angina; Index.
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