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Chapter 44: Coronary Artery Bypass Grafting and Percutaneous Interventions in Stable Ischemic Heart Disease
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Which of the following findings on noninvasive testing should prompt referral of a patient for coronary angiography?
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A. Exercise treadmill, > 2 mm of ST depression
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B. Failure to increase systolic pressure to > 120 mm Hg or a sustained decrease of > 10 mm Hg during exercise
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C. Resting perfusion abnormalities > 10% of the myocardium
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D. Stress-induced left ventricular dilatation
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The answer is E. (Hurst’s The Heart, 14th Edition, Chap. 44) Patients referred for diagnostic noninvasive stress testing should be considered for coronary angiography in the presence of high-risk findings. A number of such factors are suggested (Table 44-1; options A through D are incorrect).
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A 55-year-old man with hypertension, dyslipidemia, and type II diabetes mellitus treated with subcutaneous insulin undergoes coronary angiography following a high-risk stress test with hypotensive blood pressure response. He is found to have proximal left anterior descending coronary artery (LAD) stenosis of 85%, as well as a 70% lesion in the mid-right coronary artery.
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Which of the factors in this patient’s history would favor referral for surgical revascularization?
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B. The presence of two or more preexisting risk factors
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The answer is A. (Hurst’s The Heart, 14th Edition, Chap. 44) Patients with diabetes ...