The reasonable workup before recommending medical or surgical therapy: an overall strategy

Circulation
G C Friesinger

Abstract

The workup of a patient with chronic ischemic heart disease (IHD) before the selection of medical-surgical or medical therapy depends on multiple objective and subjective factors. These include symptoms, extent of anatomic disease (degree of coronary arteriosclerosis and left ventricular abnormalities), objective evidence of ischemia, extent of left ventricular dysfunction, and recent intercurrent ischemic events. In a minority of patients, a single factor is of overwhelming importance; e.g., the presence of severe left main coronary artery narrowing in a symptomatic patient indicates surgery is a better choice, whereas evidence of advanced left ventricular dysfunction suggests that surgery is likely to be risky and of limited help to the patient. In most instances, multiple factors should be considered before making a recommendation. The patient should be placed in the appropriate clinical subset and the objective factors that are most important in determining survival should be evaluated. Hence, an exercise electrocardiographic study to evaluate symptoms and exercise tolerance in a patient with angina pectoris and radioventriculographic studies with exercise to estimate left ventricular performance in a patient who complains ...Continue Reading

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Citations

Aug 1, 1984·Journal of the American College of Cardiology·R E PattersonS R Goldstein
Dec 1, 1985·Disease-a-month : DM·H C Sox
Apr 1, 1987·Current Problems in Cardiology·G J Dehmer
Jan 1, 1984·Postgraduate Medicine·P Greenland, M E Briody

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