Chronic stable angina risk stratification cardiac stress imaging in patients who are unable to exercise


 * Associate Editor-in-Chief: Lakshmi Gopalakrishnan, M.B.B.S.

Overview
One of the negative prognostic factor is the patients inability to perform exercise test. In patients who cannot exercise, depending on specific patient factors like heart rate, blood pressure, the presence or absence of bronchospasm, the presence of left bundle-branch block, and ventricular arrhythmias suitable type of pharmacologic stress test is advised. Pharmacological agents such as dobutamine induces stress by increasing cardiac contractility and heart rate while vasodilators such as dipyridamole or adenosine increase the overall coronary blood flow and produce regional differences in perfusion. The presence of a perfusion defect as observed with dipyridamole-thallium-201 is an independent prognostic factor. Dobutamine induced ventricular wall motion abnormalities as seen on echocardiography is associated with myocardial viability and restenosis.

==ACC / AHA Guidelines- Cardiac Stress Imaging as the Initial Test for Risk Stratification of Patients With Chronic Stable Angina Who Are Unable to Exercise (DO NOT EDIT) == {{cquote|

Class I
1. Dipyridamole or adenosine myocardial perfusion imaging or dobutamine echocardiography to identify the extent, severity, and location of ischemia in patients who do not have left bundle-branch block or electronically paced ventricular rhythm. (Level of Evidence: B)

2. Dipyridamole or adenosine myocardial perfusion imaging in patients with left bundle-branch block or electronically paced ventricular rhythm. (Level of Evidence: B)

3. Dipyridamole or adenosine myocardial perfusion imaging or dobutamine echocardiography to assess the functional significance of coronary lesions (if not already known) in planning PTCA. (Level of Evidence: B)

Class IIb
1. Dobutamine echocardiography in patients with left bundle-branch block. (Level of Evidence: C)

Class III
1. Dipyridamole or adenosine myocardial perfusion imaging or dobutamine echocardiography in patients with severe comorbidity likely to limit life expectation or prevent revascularization. (Level of Evidence: C)}}

Vote on and Suggest Revisions to the Current Guidelines

 * The Chronic Stable Angina Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines

Guidelines Resources

 * The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina


 * Guidelines on the management of stable angina pectoris: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology


 * The ACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina


 * The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina