61 research outputs found
Diagnostic and prognostic implications of exercise testing in coronary artery disease
The clinical indications for exercise testing as a diagnostic and prognostic tool in the
assessment of patients with ischemic heart disease have gradually evolved since
Master introduced the two-step exercise test in 1929 (1). New information from
correlations between electrocardiographic and angiocardiographic data, the use of
exercise test results for prognostic stratification in patient subsets and the role of
other non-invasive methods which supplement the information obtained from
exercise testing have markedly enhanced the clinical utility of the test.
Exercise testing is currently most useful in the evaluation of patients in whom the
origin of their chest pain must be elucidated, in patients with ischemic heart disease
in whom the prognosi
Diagnostic re-classification and prognostic risk stratification of patients with acute chest pain
Unstable angina and myocardial infarction
are prevalent manifestations of acute coronary artery
disease, combined in the term âacute coronary syndromesâ. The introduction of sensitive markers for
myocardial necrosis has led to confusion regarding
the distinction between small myocardial infarctions
and âtrueâ unstable angina, and the application of
ever more sensitive markers has accelerated the pace
at which patients with unstable angina are being reclassified to non-ST-segment elevation myocardial
infarction. But in how many patients with acute chest
pain is myocardial ischaemia really the cause of their
symptoms? Numerous studies have shown that most
have <5 ng/l high-sensitivity cardiac troponin, and
that their prognosis is excellent (event rate <0.5%
per year), incompatible with âimpending infarctionâ.
This marginalisation of patients with unstable angina
pectoris should lead to the demise of this diagnosis. Without unstable angina, the usefulness of the
term acute coronary syndromes may be questioned
next. It is better to abandon the term altogether and
revert to the original diagnosis of thrombus-related
acute coronary artery disease, myocardial infarction.
A national register should be the next logical step to
monitor and guide the application of effective therapeutic measures and clinical outcomes in patients
with myocardial infarction
Optimal use of coronary care units: A review
Patients at a low probability of acute cardiac pathology constitute a considerable proportion in many coronary care units (CCUs), such that physicians should consider more effective alternatives than CCU admission âto rule out myocardial infarction.â In this article, strategies to increase the efficiency of managing patients with acute chest pain are reviewed. Algorithms aiming to improve the diagnostic accuracy of the general practitioner have been developed but require an electrocardiogram recorded at the home of the patient. Another method of triage encompasses the identification in the emergency room of the hospital of patients at a low probability of acute cardiac pathology by using predictive models that include laboratory assessments. A third strategy includes alternatives to CCUs for patients at a low risk of acute cardiac pathology, such as the creation of a simple observation unit. Finally, some investigators have sought to identify patients with good prognosis for early transfer from the CCU to lower levels of care. It is concluded that a combination of these approaches will be most efficient, and that the most appropriate choice will be determined by local circumstances
Cardiac status and health-related quality of life in the long term after surgical repair of tetralogy of Fallot in infancy and childhood
The long-term results of surgical repair of tetralogy of Fallot were assessed by means of extensive cardiologic examination of 77 nonselected patients 14.7 +/- 2.9 years after surgical repair of tetralogy of Fallot in infancy and childhood. Because of the frequent use of a transannular patch (56%) for the relief of right ventricular outflow tract obstruction, the prevalence of elevated right ventricular systolic pressure was low (8%), but the prevalence of substantial right ventricular dilation with severe pulmonary regurgitation was high (58%). The exercise capacity of patients with a substantially dilated right ventricle proved to be significantly decreased (83% +/- 19% of predicted) when compared with that of patients with a near normal sized right ventricle (96% +/- 13%). Eight out of 10 patients who had needed treatment for symptomatic arrhythmia had supraventricular arrhythmia, which makes supraventricular arrhythmia--in numbers--a more important sequela in the long-term survivors than ventricular arrhythmia. Older age at the time of the operation and longer duration of follow-up were not associated with an increase in prevalence or clinical significance of sequela
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