Chest Pain and a Very Abnormal Stress Echocardiogram.
Chest Pain and a Very Abnormal Stress Echocardiogram.
复制标题
胸痛和非常异常的负荷超声心动图。
DOI：
10.1161/circulationaha.118.033885
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发表时间：
2018
期刊：
影响因子：
37.8
通讯作者：
Shenoy,Chetan
中科院分区：
文献类型：
--
作者：
Reddy,Prajwal;Birkenbach,Mark;Shenoy,Chetan
赛诺伊博士：虽然运动心动图被推荐为预测概率中等、心电图可解释且至少身体功能中等的患者的I级推荐，但运动负荷超声心动图也是该患者的合理选择(IIa级；证据级别：B)。2冠状动脉CT血管造影也是合理的(IIb类；证据级别：B)。然而，超声心动图有一个额外的优势，可以评估引起他症状的非冠脉心脏原因(如瓣膜病)，并确认他们的劳累性质。此例负荷超声心动图表现明显异常，提示为高危左主干或多支血管梗阻性冠心病。考虑到严重的呼吸困难和肺水肿，下一步应该考虑住院和冠状动脉造影术。
Dr Shenoy: Although exercise electrocardiography is recommended as a Class I recommendation for a patient with an intermediate pretest probability, interpretable ECG, and at least moderate physical functioning, exercise stress echocardiography was also a reasonable option for this patient (Class IIa; Level of Evidence: B). 2 Coronary computed tomography angiography also would have been reasonable (Class IIb; Level of Evidence: B). 2 However, echocardiography has the added advantage of evaluating noncoronary cardiac causes of his symptoms (eg, valvular heart disease) and confirming their exertional nature. The stress echocardiographic findings in this case are markedly abnormal and suggest high-risk—left main or multivessel—obstructive CAD. Given the severe dyspnea and pulmonary edema, hospitalization and coronary angiography should be considered as the next steps.