#5 Want to dominate chest pain? Wield the power of cardiac imaging and stress testing.

April 20, 2016 | By Matthew Watto, MD

In this episode we “curbside” SoCal Cardiologist, Dr. Neel Patel. If you’re like us and confused by the smorgasbord of cardiac imaging and stress testing then this show is a must listen. Whether you’re in the clinic or on call for Internal Medicine, Dr. Patel has your answers on coronary artery calcium scoring, coronary CT scans and all types of stress testing.  

Take Home Points

1. History and Physical are IMPORTANT! Make sure you listen…and examine your patient.
2. Understand who to test and who not to test for acute coronary syndrome.
   1. Low risk? The patient probably doesn’t need a test.
   2. Intermediate Risk? These people need risk stratification.
   3. High risk? These people can go straight to cath.
3. Don’t be afraid to stick with initial plan!  Negative stress test, but still worried?  Talk with your friendly neighborhood Cardiologist! 

Links

Dr. Patel recommends that you go outside. He didn’t mention this site expressly, but we think it’s a good starting point. http://www.greatoutdoors.com

Recommended reading…

NEJM Journal Watch – register here

Journal of the American College of Cardiology

Here’s a great meta analysis looking at the evaluation of chest pain in the ER.

Faranoff, AC, et al. Does This Patient With Chest Pain Have Acute Coronary Syndrome?: The Rational Clinical Examination Systematic Review. JAMA. 2015 Nov 10;314(18):1955-65. doi: 10.1001/jama.2015.12735.

The Promise trial (coronary CT versus functional testing).

Douglas, PS, et al. Outcomes of anatomical versus functional testing for coronary artery disease. N Engl J Med. 2015 Apr 2;372(14):1291-300. doi: 10.1056/NEJMoa1415516. Epub 2015 Mar 14.

Dr. Brigham mehttp://www.greatoutdoors.comntioned this article on 15 year warranty for CAC score of zero.

A 15-Year Warranty Period for Asymptomatic Individuals Without Coronary Artery Calcium: A Prospective Follow-Up of 9,715 Individuals. JACC Cardiovasc Imaging. 2015 Aug;8(8):900-9. doi: 10.1016/j.jcmg.2015.01.025. Epub 2015 Jul 15.
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