Diagnosis of Coronary Artery Disease

ABSTRACT

The routine evaluation of coronary artery disease should include a history that obtains data on the charactor of pain, age, associated symptoms, and past history. The physical examination should include vital signs, a cardiovascular and pulmonary examination. The initial resting ECG plays a central role. Exercise ECG is an appropriate first-line test for patients with an intermediate probability of coronary artery disease. Echocardiogram is as a routine test for diagnosis of the case of acute chest pain especially in patients with a systolic murmur or regional wall motion almormality. Imaging during physical or pharmacological stress is considered to be appropriate in patients for whom exercise ECG is unlikely to be useful because of baseline ECG abnormalities. Pharmacological stress with adenosine or dipyridamole is appropriate for patients who are unable to exercise. Coronary angiography is not considered clearly appropriate as routine test for diagnosis of chronic stable angina in most patients except for those who had survived sudden cardiac death. But it is considered appropriate for diagnosis of angina whose diagonsis is still uncertain after noninsasive testing. Cardiac troponin is as a preferred marker for acute ischemic injury. Biochemical cardiac markers should be performed for all patients with suspected acute myocardial infarction.