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In the diagnosis of ischemic heart disease, what is the best step in patient that can't exercise? and what's the positive test result? what's the mechanism?
you haven't spelled out the details in your question. since your patient can't exercise, has he/she already had an MI? or in other words, what is the reason why your patient can't exercise - is it low output state chronic congestive cardiac failure or waht?
first of all getting an Echocardiogram would be a good idea to evaluate for the systolic dysfunction and the current Ejection Fraction.
assuming its post MI and the patient is a high risk one
based on clinical criteria, such patients need to undergo cardiac cath and angiography to assess the state of vessels
and if they're suggestive of extensive triple vessel disease and stuff they may need urgent angioplasty/CABG - the decision between the two will be made by taking other factors into account.
post MI low risk patients can undergo symptom limited exercise testing after 2-3 weeks and if that is ok, medical management is continued,
if not, they will also require coronary angiography to assess the vessel status.
other options are
Dobutamine stress Echo,
myocardial perfusion scans to assess the infarct size and all
Sorry for the confusion. let me reconstruct my question. Let's say, for a patient who has been amputated due to diabetes who can't exercise on the treadmill stress test.
From what I've learned, for patient who can't exercise on stress treadmill,
1, either dobutamine with echocardiography or
2, persantine/thallium, adenosine /thallium.
and the positive results are accordingly:
1, decreased wall movement
2, decreased uptake
I am not sure what's the use of stress echocardiography ?? and can you name the mechanism underneath the positive results above?
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