The clinical diagnosis of stable coronary artery disease

Czech version

Authors: Slavomíra Filipová
Authors‘ workplace: Klinika kardiológie a angiológie, LF SZU, NÚSCH, a. s., Bratislava, prednosta prof. MUDr. Róbert Hatala, CSc.
Published in: Forum Diab 2015; 4(1): 22-32
Category: Topic

Overview

Chronic (stable) forms have an important role in diagnosis of coronary artery disease (CAD) in outpatients or hospitalized patients at departments of internal medicine/cardiology. Stable angina pectoris is one of the most common diagnosed cardiac conditions. Early detection of symptomatology in coronary disease accelerates the correct and complete diagnosis and initiation of treatment.

Diagnostic and differential diagnostic approach is focused on: (1) confirmation of the diagnosis of myocardial ischemia in patients with suspected coronary artery disease, (2) identify or rule out co-morbidities and accelerating factors, (3) stratification of global cardiovascular risk, (4) evaluation of efficacy of treatment in confirmed CAD.

Decision algorithm in patients with suspected stable coronary disease is carried out in three steps. Step 1 is to determine the pretest probability of the presence of CAD. In patients with moderate pre-test probability is performed step 2: non-invasive functional testing for diagnosis of stable coronary artery disease, including non-obstructive forms. Step 3 in patients with moderate pre-test probability consists of pretest risk stratification for the available non-invasive examination and execution of functional stress test(s) and therapeutic procedure is set according to the result.

Article focuses on interpretation and informative value of functional testing in diagnosis of chronic CAD: assessment of pretest probability of CAD and post-test scoring by Duke Treadmill Score. Completion of the non-invasive diagnosis of chronic CAD is followed by determination of prognosis of CAD. This is the basis for the application of lege artis (correct, according to evidence-based medicine) decision algorithm of subsequent therapy: (1) non-interventional (non-pharmacological and pharmacological and/or (2) interventional (percutaneous or cardiac revascularization).

Key words:
angina pectoris – coronary artery disease – myocardial perfusion stress testing – risk stratification of events

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