PHYS 799 Lecture Notes - Lecture 23: Aortic Stenosis, Prior Probability, Unstable Angina
7 Jun 2019
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Exercise assess w/ecg, 99mtc-tetrofosmin (myoview), echo; answers all questions; evokes ischemia. Dobutamine (beta1 agonist) assess w/myoview, ecg; answer cad present? (and possibly functional capacity, prognosis); evokes ischemia. Only; does not evoke ischemia (here we are looking at the reserve capacity) Exercise endpoint: 85% of age-predicted max (220-age + 10-12) If symptoms occur before hr target, ihd can be suspected; if no symptoms occur by target, Cad less likely; if no symptoms and pt stops before target hr, inadequate test. Contraindications for exercise testing: mi <2d ago, unstable angina, decompensated chf, symptomatic aortic stenosis, hocm (hypertrophic obstructive cardiomyopathy), uncontrolled. On ecg look for st depression signifying ischemia (horizontal st or downsloping st) On echo look for areas of the heart wall that are not contracting as well upon stress. On myoview look for areas of the heart that lose perfusion (loss of warmth) upon stress.
