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[Cardiac evaluation in arteritis]
1Clinique cardiologique, Hôpital Necker, Paris.
Insights
Coronary artery disease is a frequent cause of death in peripheral arterial disease patients. Systematic cardiac evaluation and tailored investigations like exercise stress testing are crucial for managing these high-risk individuals.
Area of Science:
- Cardiology
- Vascular Medicine
Background:
- Coronary artery disease (CAD) significantly contributes to mortality in patients with peripheral arterial disease (PAD).
- A systematic approach to cardiac assessment is essential for this patient population.
Purpose of the Study:
- To outline a systematic approach for cardiac evaluation in patients with PAD.
- To guide the selection of appropriate coronary investigations based on clinical context.
Main Methods:
- Clinical and electrocardiographic cardiac assessment.
- Exercise stress testing (EST) for suspected CAD and pre-operative evaluation.
- Pharmacological stress tests (dobutamine echocardiography, dipyridamole myocardial scintigraphy) for patients unable to perform EST.
- Coronary angiography for specific indications.
Main Results:
- EST is recommended for patients with suspected CAD or before high-risk surgery.
- Pharmacological stress tests are indicated for patients with contraindications to EST.
- Coronary angiography is reserved for patients with angina, recent myocardial infarction, or known CAD undergoing high-risk surgery.
Conclusions:
- A systematic and context-guided approach to cardiac investigations improves management of CAD in PAD patients.
- Appropriate utilization of diagnostic tools like EST and coronary angiography is key to patient outcomes.
Abstract:
Coronary artery disease is very frequent and responsible for half of the death in patients with peripheral arterial disease. Clinical and electrocardiographic cardiac check-up must be systematic. The choice of coronary investigations must be guided by the clinical context. Exercise stress testing, with upper limb if necessary, must be performed in patients with suspected coronary artery disease and before high risk surgery. Dobutamine echocardiography or dipyridamole myocardial scintigraphy are justified in patients unable to performed a satisfactory exercise stress testing. Coronary angiography must be limited to patients with angina and/or recent myocardial infarction, and to patients with known coronary artery disease and high risk surgery.