Chapter 44: Coronary Artery Bypass Grafting and Percutaneous Interventions in Stable Ischemic Heart Disease
Which of the following findings on noninvasive testing should prompt referral of a patient for coronary angiography?
A. Exercise treadmill, > 2 mm of ST depression
B. Failure to increase systolic pressure to > 120 mm Hg or a sustained decrease of > 10 mm Hg during exercise
C. Resting perfusion abnormalities > 10% of the myocardium
D. Stress-induced left ventricular dilatation
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).
Table 44-1. Criteria for Referring Patients to Coronary Angiography
Exercise treadmill, > 2 mm of ST depression;
Exercise-induced ST-segment elevation;
Exercise-induced ventricular tachycardia/ventricular fibrillation; and
Failure to increase systolic pressure to > 120 mm Hg or a sustained decrease of > 10 mm Hg during exercise
Myocardial Perfusion Imaging
Severe left ventricular dysfunction, not readily explained;
Resting perfusion abnormalities > 10% of the myocardium;
Severe stress-induced left ventricular dysfunction;
Stress-induced perfusion abnormalities involving > 10% of the myocardium or stress and mental scores indicating multiple territories at risk;
Stress-induced left ventricular dilatation; and
Increased lung uptake.
Inducible wall motion abnormalities involving > 2 segments or 2 coronary beds
Coronary Computed Tomography
Multivessel obstructive coronary disease or left main stenosis
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.
Which of the factors in this patient’s history would favor referral for surgical revascularization?
B. The presence of two or more preexisting risk factors
The answer is A. (Hurst’s The Heart, 14th Edition, Chap. 44) Patients ...