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How to examine a patient with suspected or known coronary heart disease
Julkaistu 01.06.2012 00.01
When a patient is suspected to be suffering from coronary heart disease (CHD), the first step is to assess the risk factors and symptoms to evaluate the probability of CHD. If the probability is below 20%, further investigations are usually not needed. A stress test is the primary examination for patients with moderate CHD probability (20-80%). It is useful for most patients who have typical chest pain. If after the stress test the CHD probability remains moderate, computed tomography or invasive coronary angiography are the tests of choice. For a patient with disabling symptoms or with signs of high-risk CHD, coronary angiography is the best examination. Sometimes coronary artery stenoses are observed in angiography, but the angiography does not show whether the stenoses cause ischaemia or invasive treatment is indicated. With intracoronary pressure wire measurement, the importance of a known stenosis can be evaluated by calculating the fractional flow reserve (FFR). The exact anatomy of coronary artery stenoses can be examined invasively with intravascular ultrasound or optical coherence tomography. Both of these can be used to guide coronary angioplasty and stenting especially when the stenosis to be treated is complicated.
Kari Kervinen, M.D., Cardiologist, E-mail: kari.kervinen@ppshp.fi
Matti Niemelä, M.D., Cardiologist
Juhani Valkama, M.D., Cardiologist
Department of Cardiology, Oulu University Hospital
Finnish Medical Journal 2012;67:1729–34.
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