Section I: Diagnostic Testing

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AMA Citation
Diagnostic Testing. In: Higgins JP, Ali A, Filsoof DM. Higgins J.P., Ali A, Filsoof D.M. Eds. John P. Higgins, et al.eds. Cardiology Clinical Questions New York, NY: McGraw-Hill; . http://accesscardiology.mhmedical.com/content.aspx?bookid=1819&sectionid=126678217. Accessed May 27, 2018.

MLA Citation
. "Diagnostic Testing." Cardiology Clinical Questions Higgins JP, Ali A, Filsoof DM. Higgins J.P., Ali A, Filsoof D.M. Eds. John P. Higgins, et al. New York, NY: McGraw-Hill, , http://accesscardiology.mhmedical.com/content.aspx?bookid=1819&sectionid=126678217.

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Does my patient need an electrophysiological study?

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	The decision to refer a patient for an electrophysiological study is based upon the type of conduction abnormality present.
	HPI: Episode of sudden cardiac arrest, palpitations, dyspnea, syncope, fatigue, lightheadedness. PMH: Cardiac arrest, atrioventricular block, atrial fibrillation, atrial flutter, ventricular tachycardia.
	P waves absent, biphasic "sawtooth" flutter waves present, narrow QRS complex, prolonged PR interval of fixed duration followed by a P wave that fails to conduct to the ventricles, dissociation between P wave and QRS.
	EP = Refer patient for ElectroPhysiological study. RS = Patient with Recurrent Syncope that remains unexplained after an appropriate evaluation. SND = Patient with Sinus Node Dysfunction. S-AVB = Symptomatic (palpitations, dyspnea, syncope, lightheadedness) patients in whom AtrioVentricular Block is suspected. IVCD = IntraVentricular Conduction Delay in symptomatic (palpitations, dyspnea, syncope, lightheadedness) patients. NCT = Narrow Complex Tachycardia. WCT = Wide Complex Tachycardia. SRCA = SuRvivor of Cardiac Arrest without obvious reversible cause. C-ABL = Patients with symptomatic supraventricular tachycardia due to AVNRT, symptomatic atrial tachyarrhythmias, or ventricular tachycardia amenable to Catheter ABLation.
	RS = EP SND = EP S-AVB = EP IVCD = EP NCT = EP WCT = EP SRCA = EP C-ABL = EP
	Electrophysiological studies provide valuable diagnostic information as they can determine the mechanisms of arrhythmia and help in the decision of whether drug, device, or ablation therapy is suitable.
	– The most common arrhythmia found by EPS studies is ventricular tachycardia, and the most powerful predictor is an ejection fraction of < 40%.
	Tracy CM, et al. American College of Cardiology/American Heart Association Clinical Competence Statement on Invasive Electrophysiology Studies, Catheter Ablation, and Cardioversion. Circulation. 2000;102:2309.

When do I need to order a stress test?

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	Stress testing is used in diagnosis and prognosis of coronary artery disease. It is done via exercise (treadmill, bicycle) or pharmacologic agents (adenosine, persantine, dobutamine).
	Patients with symptoms of known/probable ischemic heart disease, stable angina controlled by medicine. The most important clinical finding is chest pain.
	Determine if the patient has functional capacity to perform exercise or will need pharmacologic aid to achieve stress.
	J point depression of 0.1 mV or more and/or ST segment slope of 1 mV/s in 3 consecutive beats (during stress).
	Echocardiogram-check LVEF, wall motion abnormalities, hypertrophy.
	CAD = Coronary Artery Disease. Patients with intermediate pretest probability of CAD based on age, sex, and symptoms. RA = Risk Assessment and prognosis of symptomatic patients of those with CAD. Initial evaluation for CAD, changes in clinical status, unstable angina free of symptoms. POST-MI = Testing after Myocardial Infarction. Prognostic assessment ...