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100 Questions in Cardiology by Diana Holdright, Hugh Montgomery

By Diana Holdright, Hugh Montgomery

(BMJ Books) UCL Hospitals, London, united kingdom. greater than a hundred questions are responded via major cardiologists. functional consultant to administration of advanced events. For practitioners and citizens. Softcover.

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3 Risk stratification The initial step in risk stratification is an ECG. Patients with acute ST elevation are considered to have an acute MI and require reperfusion therapy according to local protocols. Individuals with ST depression are also at high risk and require admission for further evaluation. The presence of a positive troponin T in this group further confirms them as high risk. In situations where patients present either with a normal ECG or with T wave changes only, the value of a positive troponin T is vital in risk stratification.

The decision to stop medications prior to an exercise test depends on the drug and the reasons for using it. Some institutions withhold beta blockers for 48 hours prior to exercise testing if there is doubt about the diagnosis of coronary artery disease. g. infection, renal failure, thyrotoxicosis) Acute myocarditis or pericarditis Physical disability that would preclude safe and adequate test performance Thrombosis of lower extremity Relative Left main coronary stenosis or its equivalent Moderate stenotic valvular heart disease Electrolyte abnormalities Significant arterial or pulmonary hypertension Tachyarrhythmias or bradyarrhythmias Hypertrophic cardiomyopathy Mental impairment leading to inability to cooperate High degree atrioventricular block *Relative contraindications can be superseded if benefits outweigh risks of exercise.

Incidence and follow-up of Braunwald subgroups in unstable angina pectoris. J Am 25: 1286–92. Coll Cardiol 1995;2 2 Yusuf S, Flather M, Pogue J et al. for the OASIS (Organisation to Assess Strategies for Ischaemic Syndromes) Registry Investigators. Variations between countries in invasive cardiac procedures and outcomes in patients with suspected unstable angina or myocardial 352: 507–14. infarction without initial ST elevation. Lancet 1998;3 3 Boden WE, O’Rourke RA, Crawford MH et al. for the Veterans Affairs Non-Q Wave Infarction Strategies in Hospital (VANQWISH) Trial Investigators.

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