Chronic stable angina echocardiography

Editors-In-Chief: C. Michael Gibson, M.S., M.D. [mailto:mgibson@perfuse.org] Phone:617-632-7753; Associate Editor(s)-In-Chief: ; Smita Kohli, M.D.; Lakshmi Gopalakrishnan, M.B.B.S.

Overview
Echocardiography is useful to evaluate ventricular function and detect ischemia induced regional wall motion abnormality that occurs at rest, during exercise or with pharmacologic stress test. As a testing modality, two-dimensional echocardiography is often coupled with other testing modalities to detect regional wall motion abnormalities that most frequently occur during induced myocardial ischemia associated with coronary artery disease (CAD). Potential paired testing modalities include: upright treadmill exercise, supine bicycle ergometry, pacing, and pharmacologic stress, particularly with dobutamine. Patients with CAD may respond more adversely to testing modalities than their counterparts. Often, an adverse outcome such as the inability to perform a bicycle ergometry test or exercise treadmill protocol can be characterized as a poor prognostic factor.

Indications

 * Echocardiography is typically useful in patients with murmurs, previous MI history and ECG changes suggestive of hypertrophic cardiomyopathy.
 * Regardless of the etiology, diastolic dysfunction has a major impact on the functional status, treatment and prognosis of heart failure.
 * There is also an independent association observed between diastolic heart failure and history of ischemic heart disease, further emphasizing the use of echocardiography in patients with signs and symptoms suggestive of heart failure.
 * Resting echocardiography, doppler imaging and strain rate measurement have improved the ability to identify undetected diastolic dysfunction in chronic stable angina patients without heart failure.

==ACC / AHA Guidelines- Echocardiography at Rest (DO NOT EDIT) == {{cquote|

Class I
1. Patients with a systolic murmur suggestive of aortic stenosis and/or hypertrophic cardiomyopathy. (Level of Evidence: C)

2. Evaluation of extent (severity) of ischemia (e.g., left ventroicular segmental wall motion abnormality) when the echocardiogram can be obtained during pain or within 30 minutes after its abatement. (Level of Evidence: C)

Class IIb
1. Patients with a click and/or murmur to diagnose mitral valve prolapse. (Level of Evidence: C)

Class III
1. Patients with a normal ECG, no history of MI, and no signs or symptoms suggestive of heart failure, valvular heart disease, or hypertrophic cardiomyopathy. (Level of Evidence: C)}}

==ESC Guidelines- Echocardiography for initial diagnostic assessment of angina (DO NOT EDIT) == {{cquote|

Class I
1. Patients with abnormal auscultation suggesting valvular heart disease or hypertrophic cardiomyopathy. (Level of Evidence: B)

2. Patients with suspected heart failure. (Level of Evidence: B)

3. Patients with prior MI. (Level of Evidence: B)

4. Patients with LBBB, Q waves, or other signiﬁcant pathological changes on ECG, including ECG criteria for LVH. (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