scholarly journals Chest Pain and Exercise Induced Ischemia with Angiographically Insignificant Coronary Arterial Disease: Clinical Presentation and Follow-Up

1970 ◽  
Vol 6 (1) ◽  
pp. 27-31
Author(s):  
Md Khurshed Ahmed ◽  
Mohammad Salman ◽  
Md Ashraf Uddin Sultan ◽  
Md Abu Siddique ◽  
KMHS Sirajul Haque ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Chest Pain ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Coronary Angiogram ◽  
Ecg Changes ◽  
History Of

Angiography of patients with typical chest pain reveals normal epicardial coronary arteries in about 15-20%. ECG changes suggestive of myocardial ischemia during exercise also can be demonstrated in this subset of the patients. Total 58 patients (42 females) with mean age 42±7 years who were undergoing coronary angiogram in the Department of Cardiology, University Cardiac Center, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from January 2005 to December 2009 were evaluated. The patients were recruited on the basis of presence of history of chest pain, with normal resting ECG and ischemia like ECG changes during exercise stress test. 32.8% patients had hypertension and 15.5% were diabetics, 19.0% had dyslipidemia and 6.9% had family history of ischemic heart disease. All the patients were having positive exercise stress test. Angiographic findings showed luminal irregularities in 29.3% patients, 15.5% patients had luminal stenosis less than 30% and rest had normal coronary angiogram. Follow up of the patients after one and six months of angiogram was done. After one month 63.8% patients remained symptomatic and after six months 63.3% patients remained symptomatic despite maximum medical management. The pathophysiology and appropriate management of this subset of the patients still remained a challenge for physicians. Optimum management of cardiovascular risk factors is very important issue in this group of patients.Key words: Angiography; Epicardial coronary arteries; Exercise stress test; Cardiovascular risk factors. DOI: 10.3329/uhj.v6i1.7187University Heart Journal Vol.6(1) 2010 pp.27-31

scholarly journals Emergency department patient compliance with follow-up for outpatient exercise stress testing: a randomized controlled trial

CJEM ◽  
2007 ◽  
Vol 9 (06) ◽  
pp. 435-440 ◽  
Author(s):  
Doug Richards ◽  
Nazanin Meshkat ◽  
Jaqueline Chu ◽  
Kevin Eva ◽  
Andrew Worster
Keyword(s):  
Chest Pain ◽  
Stress Testing ◽  
Stress Test ◽  
Intervention Group ◽  
Exercise Stress Test ◽  
Low Risk ◽  
Exercise Stress ◽  
Exercise Stress Testing ◽  
Control Group

ABSTRACTIntroduction:Numerous patients are assessed in the emergency department (ED) for chest pain suggestive of acute coronary syndrome (ACS) and subsequently discharged if found to be at low risk. Exercise stress testing is frequently advised as a follow-up investigation for low-risk patients; however, compliance with such recommendations is poorly understood. We sought to determine if compliance with follow-up for exercise stress testing is higher in patients for whom the investigation is ordered at the time of ED discharge, compared with patients who are advised to arrange testing through their family physician (FP).Methods:Low-risk chest pain patients being discharged from the ED for outpatient exercise stress test and FP follow-up were randomized into 2 groups. ED staff ordered an exercise stress test for the intervention group, and the control group was advised to contact their FP to arrange testing. The primary outcome was completion of an exercise stress test at 30 days, confirmed through both patient contact and stress test results. Patients were unaware that our primary interest was their compliance with the exercise stress testing recommendations.Results:Two-hundred and thirty-one patients were enrolled and baseline characteristics were similar between the 2 groups. Completion of an exercise stress test at 30 days occurred in 87 out of 120 (72.5%) patients in the intervention group and 60 out of 107 (56.1%) patients in the control group. The difference in compliance rates (16.4%) between the 2 groups was statistically significant (χ2= 6.69,p< 0.001) with a relative risk of 1.29 (95% confidence interval 1.18–1.40), and the results remained significant after a “worst case” sensitivity analysis involving 4 control group cases lost to follow-up. When subjects were contacted by telephone 30 days after the ED visit, 60% of those who were noncompliant patients felt they did not have a heart problem and that further testing was unnecessary.Conclusion:When ED staff order an outpatient exercise stress test following investigation for potential ACS, patients are more likely to complete the test if it is booked for them before ED discharge. After discharge, many low-risk chest pain patients feel they are not at risk and do not return to their FP for further testing in a timely manner as advised. Changing to a strategy of ED booking of exercise stress testing may help earlier identification of patients with coronary heart disease.

Bizarre electrocardiographic changes during occlusion of a congenital coronary arteriovenous fistula

2012 ◽  
Vol 23 (2) ◽  
pp. 295-298 ◽  
Author(s):  
Ramazan Akdemir ◽  
Ekrem Yeter ◽  
Harun Kilic ◽  
Murat Yucel
Keyword(s):  
Chest Pain ◽  
Arteriovenous Fistula ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Coronary Arteriovenous Fistula ◽  
St Segment ◽  
History Of ◽  
Electrocardiographic Changes ◽  
Electrocardiographic Recordings

AbstractA 38-year-old man who had a history of percutaneous coronary artery coil occlusion was admitted to our hospital with chest pain and shortness of breath. His complaint was chest pain, which is typical. ST depressions were observed during the treadmill exercise stress test. Coronary angiography demonstrated the persistence of a coronary arteriovenous fistula and coils in the fistula. Primarily, additional coil placement inside the arteriovenous fistula was decided as the mode of treatment. The coil was first placed inside the arteriovenous fistula and then an attempt was made to detach it. However, it was unsuccessful after four trials and electrical detachment of more than 3 minutes. Finally, a 2.5 × 18-millimetre graft stent was deployed at 20 atmospheric pressure. Electrocardiographic recordings showed bizarre ST segment changes during the electrical detachment of the coil. In this report, we discuss the concealed bizarre electrocardiographic changes that were seen during coronary arteriovenous fistula occlusion.

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.

Essential Thrombocythemia: Analysis of Risk Factors for Thrombotic Events in a Series of 306 Patients.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 4937-4937
Author(s):  
Franca Radaelli ◽  
Stefania Bramanti ◽  
Mariangela Colombi ◽  
Alessandra Iurlo ◽  
Alberto Zanella
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Essential Thrombocythemia ◽  
Thrombotic Event ◽  
Previous History ◽  
Significant Difference ◽  
Platelet Number ◽  
History Of

Abstract Essential thrombocythemia (ET) is a chronic myeloproliferative disorder characterized by peripheral thrombocytosis and abnormal proliferation of megakariocytes in the bone marrow. Even thought thrombosis is frequently associated to ET, the risk factors of this clinical complication are still controversial. The aim of this retrospective, single institution study was to investigate clinical and laboratory characteristics associated with the occurrence of thrombotic events, with the purpose of identifying subgroups of patients who could benefit from antiaggregant and/or cytostatic treatment. 306 consecutive ET patients (109 men and 197 females, median age 58 yr) diagnosed between January 1979 and December 2002 were included in the study. At the time of analysis, 196 patients were still alive with a median follow up of 96 months. The following variables were investigated for the association with thrombotic complications: age, platelet count, previous history of thrombotic events, time from diagnosis, treatment with antiaggregant/cytostatic drugs, and cardiovascular risk factors such as arterial hypertension, obesity, hypercolesterolemia, diabetes, cigarette smoking. At the time of last follow up, 46 patients (15%) experienced at least one thrombotic event. The occurrence of thrombotic events was observed in 26/64 (40.6%) patients with previous history of thrombosis and in 20/242 (8.3%) patients with no previous history of thrombosis (p&lt;0.0001 Fisher’s exact test, odd ratio 7.6). A significant difference between the two groups of patients was also confirmed when Kaplan Meier estimates of thrombosis-free survival were compared by log-rank test (p&lt;0.0001). By logistic regression, platelet number at diagnosis did not associate with occurrence of thrombosis in the whole patient population. When patients without previous history of thrombosis were stratified according to the number of cardiovascular risk factors (none vs one vs more than one), a significant correlation with occurrence of thrombotic events was observed (Mantel-Haenszel Chi-square 5.47, p&lt;0.05). This study confirms that history of thrombosis is strongly related with risk of further thrombotic events in patients with ET, whereas platelet number at diagnosis does not seem to represent a prognostic factor. In patients with no previous history of thrombosis, the presence of other cardiovascular risk factors has to be taken into account when establishing the therapeutic approach.

Using Incremental High-Sensitive Cardiac Troponin T to Increase the Diagnostic Accuracy of Exercise Stress Test

2021 ◽  
Vol 104 (2) ◽  
pp. 169-175
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Cardiac Troponin ◽  
Troponin T ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Cardiac Troponin T ◽  
Delta Change ◽  
Artery Disease

Background: Exercise stress test (EST) is the most practical method to diagnose coronary artery disease (CAD). Although it has a high negative predictive value (NPV), the positive predictive value (PPV) is low. Objective: To increase the diagnostic accuracy of EST by combining the results with the delta change of high-sensitive cardiac troponin T (hscTnT) levels during stress exercise. Materials and Methods: The authors conducted a diagnostic study in patients presenting with chest pain and having intermediate pretest probability of CAD who underwent EST at Queen Sirikit Heart Center of the Northeast in Khon Kaen, Thailand, between July 2018 and January 2019. Two blood samples were collected to measure hs-cTnT at 5-minute before and at 1-hour after exercise. The diagnosis of CAD was made from the coronary angiography (CAG) or coronary computed tomography angiography (CCTA) result. The authors created a ROC curve from the hs-cTnT delta change, selected a value that had high sensitivity, and combined it with EST results to enhance the PPV predicting CAD. Results: Eighty-one patients were included in the present study. Thirty-one (38.3%) had positive EST, 47 (58.0%) had negative EST, and three (3.7%) had inconclusive results. To confirm the diagnosis of significant CAD, CAG was performed in 33 (40.7%) patients, and CCTA was performed in seven (8.6%) patients. Forty-two (51.8%) patients were determined not to have significant CAD based solely on negative EST results. Sixteen (19.8%) patients were in the CAD group and 65 (80.2%) in the non-CAD group. The average hs-cTnT at baseline, at 1-hour after EST, and delta change of patients in the CAD group were greater than those in the non-CAD group (7.81±3.62 ng/L and 4.83±2.97 ng/L, p<0.001, 9.21±4.41 ng/L and 4.94±2.92 ng/L, p<0.001, 17.99% and 9.18%, p=0.09, respectively). When the authors used a hs-cTnT delta-change of 3% as a cutoff point and combined this with the EST results, the PPV increased from 48% when using the EST alone to 63.2%. Conclusion: Combining hs-cTnT delta change during an EST with EST results could raise the PPV of CAD diagnosis in patients with chest pain who had intermediate CAD pretest probability. Keywords: Exercise stress test, Coronary artery disease, High-sensitive cardiac troponin T

scholarly journals Microvascular Angina　― Long-Term Exercise Stress Test Follow-up ―

2018 ◽  
Vol 82 (4) ◽  
pp. 1070-1075 ◽  
Author(s):  
Gaetano A. Lanza ◽  
Monica Filice ◽  
Antonio De Vita ◽  
Angelo Villano ◽  
Laura Manfredonia ◽  
...  
Keyword(s):  
Stress Test ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Microvascular Angina
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