scholarly journals Dizziness in an avid cyclist: an unusual presentation of a common problem

2021 ◽  
Vol 5 (12) ◽  
Author(s):  
Aish Sinha ◽  
Ozan M Demir ◽  
Howard Ellis ◽  
Divaka Perera
Keyword(s):  
Stress Test ◽  
Obstructive Coronary Artery Disease ◽  
Exercise Stress Test ◽  
Coronary Intervention ◽  
Exercise Stress ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Wide Range ◽  
Artery Disease ◽  
And Gender

Abstract Background Presyncope and syncope are common presentations with a wide range of differential diagnoses; when it occurs primarily on exertion, a cardiovascular cause is more likely. Structural abnormalities and primary rhythm disturbances are the usual culprits in these patients. Case summary A 75-year-old gentleman presented with a history of progressive exertional presyncope. His investigations demonstrated normal cardiac structure, function, and rhythm. He underwent an exercise stress test, which demonstrated a significant reduction in peak blood pressure with equivocal electrocardiogram changes and absence of ischaemic symptoms. In view of his age and gender, a computerized tomography coronary angiogram (CTCA) was organized to exclude obstructive coronary artery disease (CAD). Intriguingly, the CTCA demonstrated a severe proximal left anterior descending (LAD) artery stenosis. This stenosis was confirmed to be functionally significant using invasive coronary physiology and was treated with percutaneous coronary intervention. At follow-up, there was no recurrence of exertional presyncope and the patient was continuing to return to his baseline function. Conclusion Presyncope and/or syncope as the sole manifestation of obstructive CAD, in the presence of normal ventricular function and valves, has rarely been reported. Myocardial ischaemia-mediated presyncope and/or syncope may be secondary to numerous mechanisms, which are described in this case report. Revascularization of the functionally significant proximal LAD stenosis resulted in cessation of exertional presyncope in our patient. The long-term outcome of revascularization in patients with presyncope and syncope needs to be further investigated.

scholarly journals Exercise Stress Test Utility in Patients with Chest Pain Presumed to be of Cardiac Origin

2013 ◽  
Vol 12 (3) ◽  
pp. 146-150
Author(s):  
Philippa Bennett ◽  
◽  
Philip Dyer ◽  
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Stress Test ◽  
Obstructive Coronary Artery Disease ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Stress Tests ◽  
Prognostic Information ◽  
Artery Disease

Introduction: NICE stated exercise stress tests (EST) should not be used to diagnose obstructive coronary artery disease in patients presenting with chest pain presumed to be of cardiac origin. Methods: A retrospective review of 209 patients with presumed cardiac chest pain was done. EST results, GRACE scores and need for invasive coronary angiogram (ICA) were analysed to predict the need for readmission, intervention and future events. Results: The sensitivity of the EST in identifying obstructive coronary artery disease was 70%. The EST, ICA and the GRACE 6-month mortality had a 77%, 70% and 81% negative predictive value (NPV) for readmission respectively. Conclusion: EST, GRACE scores and ICA are useful in providing prognostic information but are poor predictors of readmission. Follow up and education programmes are needed to reduce this burden.

Abstract P442: Apparently Healthy Fit Asymptomatic Adults Are Not Immune To Sub-clinical Atherosclerosis

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Robert Scales ◽  
Kathryn A Cornella ◽  
Mohan Vardhini ◽  
Cengiz Akalan ◽  
Qing Wu ◽  
...  
Keyword(s):  
Stress Test ◽  
Exercise Stress Test ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Exercise Stress ◽  
Prior History ◽  
Carotid Artery Plaque ◽  
History Of ◽  
And Gender ◽  
Apparently Healthy

Evidence suggests that cardiovascular (CV) fitness below the 20 th percentile for age and gender is associated with increased cardiac death and all cause mortality. This study assessed the association between CV fitness and sub-clinical atherosclerosis (SCA) in a self-selected group of participants in a cardiology-based prevention program. The study involved a single visit observation of participants. 240 apparently healthy asymptomatic adults <65 years (69% male) received a maximal graded exercise stress test and a carotid intima-media thickness (CIMT) evaluation with B-mode ultrasound. CV fitness was classified based on age-gender norms (very poor=1-19 th , poor=20-39 th , fair=40-59 th , good=60-79 th , excellent/superior=80-100 th percentile). CIMT was used to define CV health based on age-gender-race norms. SCA was considered present when there was non-occlusive carotid artery plaque (>1.5mm and >50% of the surrounding intima-media) or CIMT >75 th percentile. Anyone with a prior history of clinically apparent atherosclerosis or diabetes was excluded from the study. The mean age of participants was 50 yrs (SD= 8.7). 113 participants (47%) had excellent/superior CV fitness. 41 (17%) were classified good, 36 (15%) fair, 20 (8%) poor and 30 (12%) very poor. 69 (61%) participants with excellent/superior CV fitness had advanced atherosclerosis (plaque=43%; n=49 or CIMT >75 th percentile=l7%; n=20). In the good classification there were 26 (64%) with plaque (49%; n=20) or CIMT >75 th percentile (15%; n=6). There were 23 (63%) in the fair classification with plaque (44%; n=16) or CIMT >75 th percentile (19%; n=7), 11 (55%) in the poor classification with plaque (45%; n=9) or CIMT >75 th percentile (10%; n=2) and 17 (56%) in the very poor classification with plaque (53%; n=16) or CIMT >75 th percentile (3%; n=1). 58 (24%) of the total number of participants were classified with superior CV fitness (95-100 th percentile); of which 36 (62%) had SCA (plaque=45%; n=26 or CIMT >75 th percentile=17%; n=10). In this self-selected population, CIMT testing detected evidence of SCA across all age-gender fitness classifications, which included very fit individuals. Further investigation is needed to identify other factors that may be associated with increased CV risk in apparently healthy fit asymptomatic adults.

Imaging functional stress test for stable chest pain symptoms in patients at low pretest probability of coronary artery disease: Current practice and long‐term outcome

2019 ◽  
Vol 36 (6) ◽  
pp. 1095-1102 ◽  
Author(s):  
Nicola Gaibazzi ◽  
Andrea Barbieri ◽  
Giuseppe Boriani ◽  
Giorgio Benatti ◽  
Gabriella Codazzo ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Current Practice ◽  
Stress Test ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Artery Disease ◽  
Stable Chest Pain ◽  
Pain Symptoms ◽  
Functional Stress

Hemodynamic Characteristics of Patients with Coronary Artery Disease Presenting False-Negative Exercise Stress Test

Angiology ◽  
1992 ◽  
Vol 43 (6) ◽  
pp. 506-511 ◽  
Author(s):  
Michihito Sekiya ◽  
Makoto Suzuki ◽  
Yasushi Fujiwara ◽  
Takumi Sumimoto ◽  
Mareomi Hamada ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Stress Test ◽  
False Negative ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Hemodynamic Characteristics ◽  
Artery Disease

Recent advances in the role of the adenosinergic system in coronary artery disease

2020 ◽  
Author(s):  
Franck Paganelli ◽  
Marine Gaudry ◽  
Jean Ruf ◽  
Régis Guieu
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Tissue Hypoxia ◽  
Exercise Stress ◽  
Fractional Flow ◽  
Coronary Syndrome ◽  
Flow Reserve ◽  
Artery Disease

Abstract Adenosine is an endogenous nucleoside that plays a major role in the physiology and physiopathology of the coronary artery system, mainly by activating its A2A receptors (A2AR). Adenosine is released by myocardial, endothelial, and immune cells during hypoxia, ischaemia, or inflammation, each condition being present in coronary artery disease (CAD). While activation of A2AR improves coronary blood circulation and leads to anti-inflammatory effects, down-regulation of A2AR has many deleterious effects during CAD. A decrease in the level and/or activity of A2AR leads to: (i) lack of vasodilation, which decreases blood flow, leading to a decrease in myocardial oxygenation and tissue hypoxia; (ii) an increase in the immune response, favouring inflammation; and (iii) platelet aggregation, which therefore participates, in part, in the formation of a fibrin-platelet thrombus after the rupture or erosion of the plaque, leading to the occurrence of acute coronary syndrome. Inflammation contributes to the development of atherosclerosis, leading to myocardial ischaemia, which in turn leads to tissue hypoxia. Therefore, a vicious circle is created that maintains and aggravates CAD. In some cases, studying the adenosinergic profile can help assess the severity of CAD. In fact, inducible ischaemia in CAD patients, as assessed by exercise stress test or fractional flow reserve, is associated with the presence of a reserve of A2AR called spare receptors. The purpose of this review is to present emerging experimental evidence supporting the existence of this adaptive adenosinergic response to ischaemia or inflammation in CAD. We believe that we have achieved a breakthrough in the understanding and modelling of spare A2AR, based upon a new concept allowing for a new and non-invasive CAD management.

Prognostic Value of Exercise Stress Test and Dobutamine Stress Echo in Patients with Known Coronary Artery Disease

2009 ◽  
Vol 26 (1) ◽  
pp. 1-9 ◽  
Author(s):  
Francesca Innocenti ◽  
Francesca Caldi ◽  
Irene Tassinari ◽  
Chiara Agresti ◽  
Costanza Burgisser ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Prognostic Value ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Dobutamine Stress ◽  
Exercise Stress ◽  
Stress Echo ◽  
Artery Disease
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