Diagnosis and evaluation of ischemic heart disease

  • M. Sangiorgi
  • D. De Nardo

Abstract

Diagnostic approach to coronary artery disease patients primarily involves the internist Anamnesis, physical examination and evaluation of risk factors enable the internist to assess a priori the pretest probability of coronary artery disease (CAD). Therefore a diagnostic iter will be started employing a sequence of independent tests. The goal of the sequence is to obtain a growing acquisition of knowledge in order to place the patient into a sufficiently low or high disease probability category.This approach is based on the sequential bayesian analysis, the statistical law of conditional probability, which states that the posttest probability can not be directly assessed only by the test result but it is influenced by the prevalence of disease, namely pretest probability. This clinical procedure is effective in the vast majority of patients, and yet some limiting factors to a strict bayesian approach have to be considered. Sometimes the tests employed are not independent, the test results are not absolutely negative or positive and prominently we have not an adequate gold standard representing an ideal marker of myocardial ischemia.

Keywords

Myocardial Blood Flow Coronary Artery Disease Patient Mitral Valve Prolapse Pretest Probability Holter Monitoring 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1).
    Autore, Fragola. P.. Pitucco. G. et al (1983) “La cardiopatia ischemica nella donna. Validita’ diagnostica dell’uso combinato della prova da sforzo e della scintigrafia miocardica con Tallio-201”. Clin Ter Gardiovasc 2,5. 247–258.Google Scholar
  2. 2).
    Belier, George A and Gibson, Robert S. (1987) “Sensibilita’, specificit’ e significato prognostico delle metodiche di valutazione non invasiva per la coronaropatia occulta o manifesta”. Prog in Pat Cardiovasc 30, 3, 187–221.Google Scholar
  3. 3).
    Caputo. V., De Nardo, D., De Angelis, A. et al (1983) “Possibilities of Thallium-201 myocardial scintigraphy in effort angina diagnosis”, in M. Salvatore and E.Porta (eds.) Radioisotopes in Cardiology, Plenum Publishing Corporation, pp. 295–300.Google Scholar
  4. 4).
    Caputo. V., De Nardo, D., Antolini M.. et al (1987) “Il test al Dipiridamoloe la scintigrafia miocardica con Tl-201 nella diagnosi della patologia ischemica miocardica”, Radiol Med 73, 390–393.PubMedGoogle Scholar
  5. 5).
    Ciavolella M., Giannitti, C.. Scali, D. et al (1989) “Incremento di accuratezza nella diagnosi di cardiopatia ischemica mediante valutazione radioisotopica simultanea della funzione ventricolare regionale e della perfusione miocardica ed unico test ergometrico”, Atti L Congresso Soc It Cardiol.Google Scholar
  6. 6).
    De Nardo.D., Antolini.M.. Pitucco,G. et al (1988) “Effects of left bundle branch block, on left ventricular function in apparently normal subjects.Study by equilibrium radionuclide angiocardiography at rest”, Cardiology 75, 5. 365–371.PubMedCrossRefGoogle Scholar
  7. 7).
    Esquivel. L., Pollock:. Stewart G.. Belier. George A. et al (1989) “Effect of the degree of effort on the sensitivity of the exercise Thallium-201 stress test in symptomatic coronary artery disease”, Am J Cardiol 63, 160–165.Google Scholar
  8. 8).
    Factor, S. and Sonnenblick. E. (1982) “Hypothesis: Is congestive cardiomyopathy caused by a hyperreactive myocardial microcirculation (microvascular spasm) ?”, Am J Cardiol 50. 1149–1152.PubMedCrossRefGoogle Scholar
  9. 9).
    Fragola, P., Autore, C. Pierangeli. L. et al (1984) “L’uso combinato dell elettrocardiogramma da sforzo e della scintigrafia miocardica con Tallio-201 in soggetti con sospetta cardiopatia ischemica”. Gin Ter Cardiovasc 3–4, 105–113.Google Scholar
  10. 10).
    Kaul, S. (1989) “Cardiac imaging in conjunction with exercise stress testing in patients with suspected coronary artery disease: a comparison of the techniques”, Cardiovasc Imag 1, 20–28.Google Scholar
  11. 11).
    Mora, B., Douard, H., Barat, J.P. et al (1987) “Apparition simultanee d’un bloc de branche gauche et d’une douleur thoracique a l’effort”, Arch Mal Coeur 80.12,1807–1811.Google Scholar
  12. 12).
    Pozzati, A. Morgagni. GL., Ottani. F. et al (1989) “Abnorme risposta coronarica a stimoli vasomoton: analogie tra angina variante e sindrome X”. Cardiologia 34, 5, 411–418.PubMedGoogle Scholar
  13. 13).
    Rozanski. A and Berman. Daniel. S. (1987) “The efficacy of cardiovascular nuclear medicine exercise studies”, Seminars in Nuclear Medicine 17, 2, 104–120.Google Scholar
  14. 14).
    Rozanski, A, Diamond G.. Forrester, J. et al (1983) “The declining specificity of exercise radionuclide ventriculography”. N Engl J Med 309. 518–522.PubMedCrossRefGoogle Scholar
  15. 15).
    Tartagni, F., Melandri, G., Tomassini, F. et al (1986) “Significato della positività’ della scintigrafia miocardica da sforzo nei pazienti a coronarie indenni: correlazioni clinicostrumentali”. Cardiologia 31, L, 23–27.Google Scholar
  16. 16).
    Tzivoni, D., Gavish, A, Gottlieb, S. et al (1988) “Prognostic significance of ischemic episodes in patients with previous myocardial infarction”. Am J Cardiol 62, 661–664.PubMedCrossRefGoogle Scholar
  17. 17).
    Weiner. D.. Ryan. T.. McCabe. G et al (1979) “Exercise stress testing. Correlation among history of angina, ST segment response and prevalence of coronary artery disease in the Coronary Artery Surgery Study (CASS)”, N Engl J Med 301, 230–235.PubMedCrossRefGoogle Scholar

Copyright information

© Kluwer Academic Publishers 1990

Authors and Affiliations

  • M. Sangiorgi
    • 1
    • 2
  • D. De Nardo
    • 1
  1. 1.Department of Internal Medicine, Institute of “Clinica Medica”II University of Rome“Tor Vegata”Italy
  2. 2.II University of Rome, Ospedale S. Eugenio p.le dell’UmanesimoRomeItaly

Personalised recommendations