Study of angina pectoris

angina pectorisThe basis for the investigation of the symptom of angina pectoris as well as to establish its cause, is the clinical examination (history and physical examination). Between attacks of angina pectoris or even during a crisis, physical examination and electrocardiogram may reveal little or no changes. Certain tests assist in the diagnosis and estimation of severity of myocardial ischemia and the extent of coronary artery disease.

The stress test or treadmill – examination in which the patient walks on a treadmill while being monitored by continuous electrocardiogram – can help in the diagnosis, usually being the first test to be requested after the electrocardiogram. The study with radioactive (radioisotopes), called myocardial perfusion scintigraphy, can be combined with the stress test. Thus, scintigraphy has a higher sensitivity for detecting the presence of myocardial ischemia. This exam through tomographic images, analyzes the degree of radioisotope uptake by heart muscle.

The stress echocardiogram is a test in which images are obtained of the heart through ultrasound waves. The images of echocardiograms are obtained at rest and during stress with exercise or after the infusion of a drug called dobutamine. When there is ischemia, the movement of contraction of the heart muscle is abnormal.

Depending on the clinical condition or the results of the tests mentioned above, the physician may order carrying out a CT angiography or cardiac catheterization and coronary angiography – contrast examination of the coronary arteries. These procedures are most commonly used for determining the severity of coronary artery disease, assessing whether or not a specific procedure to improve blood flow, ie, coronary angioplasty or bypass surgery (CABG).

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