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Published on: October 6, 2023
Detection and management of coronary artery disease in patients with rheumatologic disorders
1Department of Cardiology, Cleveland Clinic Foundation, Ohio, USA.
Insights
Coronary heart disease (CHD) risk is higher in rheumatic disorders. Noninvasive tests like stress echocardiography or thallium scans help diagnose CHD in patients with chest pain or dyspnea.
Area of Science:
- Cardiology
- Diagnostic Imaging
Background:
- Coronary heart disease (CHD) is a major cause of morbidity and mortality.
- Patients with rheumatic disorders have a higher prevalence of CHD.
- Accurate diagnosis of CHD is crucial for effective management.
Purpose of the Study:
- To outline the diagnostic approach for coronary artery disease (CAD) in patients presenting with chest pain or dyspnea.
- To detail the role of noninvasive testing in CAD diagnosis.
- To guide the selection of appropriate diagnostic modalities based on patient characteristics.
Main Methods:
- Emphasis on thorough patient history to assess CAD risk.
- Noninvasive testing selection based on patient's ability to exercise.
- Stress echocardiography (treadmill or bike) for active patients.
- Dobutamine stress echocardiography for inactive patients.
- Exercise thallium or dipyridamole thallium as alternatives when echocardiography is not feasible or expertise is limited.
Main Results:
- Stress echocardiography allows direct visualization of myocardial ischemia through wall motion abnormalities.
- Alternative noninvasive tests are available for patients unable to exercise or with specific conditions (e.g., atrial fibrillation, pacemakers).
- An ischemic response often necessitates further evaluation with cardiac catheterization.
Conclusions:
- A systematic, noninvasive approach is essential for diagnosing CAD in symptomatic patients.
- The choice of diagnostic test should be tailored to individual patient factors and clinical presentation.
- Accurate diagnosis facilitates informed therapeutic decisions for managing coronary artery disease.
Abstract:
Coronary heart disease causes significant morbidity and mortality in our society and is more common in patients with some rheumatic disorders. A thorough history is the most essential element in assessing patients with chest pain syndrome or dyspnea who are at risk of harboring coronary artery disease. Based on the level of suspicion, a noninvasive test is commonly ordered to confirm the diagnosis. If a patient is active and can exercise, then treadmill or bike stress echocardiography is recommended. In addition to assessment of valvular, pericardial, and myocardial function at rest, stress echocardiography permits direct visualization of left ventricular cavity enlargement or wall motion abnormalities, which imply significant myocardial ischemia. If the echocardiography laboratory does not have sufficient expertise or experience with this technique, then exercise thallium is the next study of choice. If a patient is inactive or is unable to exercise, then dobutamine stress echocardiography is recommended. For patients who are in atrial fibrillation, have permanent pacemakers, who cannot augment their heart rate to a minimum of 85% MPHR, dipyridamole thallium is an acceptable alternative. An ischemic response in a symptomatic patient in most cases requires further evaluation with cardiac catheterization. Based on the patient's clinical presentation and physiologic and anatomic findings, important therapeutic decisions can then be made.
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01:22Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies
01:21Rheumatic Heart Disease III: Medical Management
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