Materiały źródłowe

• #1 Coronary Artery Disease (CAD): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/16898-coronary-artery-disease

  Coronary artery disease (CAD) limits blood flow in your coronary arteries, which deliver blood to your heart muscle. […] CAD can lead to a heart attack, abnormal heart rhythms or heart failure. […] Coronary artery disease (CAD) is a narrowing or blockage of your coronary arteries, which supply oxygen-rich blood to your heart. […] This happens because, over time, plaque (including cholesterol) buildup in these arteries limits how much blood can reach your heart muscle. […] You might have CAD for many years and not have any symptoms until you experience a heart attack. […] Coronary artery disease is very common. Over 18 million adults in the U.S. have coronary artery disease. […] In 2021, coronary artery disease killed 375,500 people in the U.S. […] Coronary artery disease is the leading cause of death in the U.S. and around the world.

• #2 Coronary Artery Disease (CAD): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/16898-coronary-artery-disease

  Atherosclerosis causes coronary artery disease. […] When the plaque affects blood flow in your coronary arteries, you have coronary artery disease. […] Your provider may also recommend one or more tests to assess your heart function and diagnose CAD. […] Healthcare providers diagnose coronary artery disease through a physical exam and testing. […] Your healthcare provider will talk with you about the best treatment plan for you. […] Coronary artery disease treatment often includes lifestyle changes, risk factor management and medications. […] Some people need a procedure or surgery to manage coronary artery disease, including: Percutaneous coronary intervention (PCI) and Coronary artery bypass grafting (CABG). […] You cant always prevent coronary artery disease because some risk factors are out of your control.

• #3 Coronary Artery Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK564304/

  Coronary artery disease (CAD) is a prevalent heart condition characterized by the buildup of atherosclerotic plaque within the arterial lumen. Blood flow impairment reduces oxygen delivery to the myocardium. CAD is the most common cause of major morbidity and mortality in the US and worldwide. Prompt diagnosis and treatment improve outcomes. […] The evaluation of CAD typically involves a combination of clinical assessment and diagnostic tests such as electrocardiography, stress testing, and echocardiography. Coronary angiography helps assess the extent of coronary blockages. […] Several modalities are highly useful in evaluating CAD, including ECG, echocardiography, chest radiography, stress testing, cardiac catheterization, and serum markers. Patient presentation dictates how these tests are utilized. Below are details on different diagnostic modalities available for the evaluation of CAD.

• #3 Coronary Artery Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK564304/

  ACS presents as sudden-onset substernal chest pain or pressure, typically radiating to the neck and left arm, and may be accompanied by dyspnea, palpitations, dizziness, syncope, cardiac arrest, or new-onset congestive heart failure. Prompt ECG testing is necessary for all patients with ACS to assess for STEMI.

• #3 Coronary Artery Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK564304/

  ECG is a fundamental yet enormously helpful test in evaluating CAD. ECG measures electrical activity in the cardiac conduction system, measured by 10 leads attached to the skin at standardized locations. This modality provides information about the heart’s anatomy and physiology. […] Cardiac catheterization is the gold standard and most accurate modality for evaluating ischemic coronary heart disease. Coronary angiography is used to assess the type and number of affected vessels and the severity of stenosis, which are essential in determining the appropriate approach for coronary intervention. However, this invasive procedure has potentially serious complications, and not everyone is a candidate for it. […] CAD could present either as SIHD or ACS. The management depends on the particular disease type, as discussed below.

• #4 Coronary Artery Disease | CAD | MedlinePlus

  https://medlineplus.gov/coronaryarterydisease.html

  Coronary artery disease (CAD) is the most common type of heart disease. It is the leading cause of death in the United States in both men and women. […] CAD happens when the arteries that supply blood to heart muscle become hardened and narrowed. This is due to the buildup of cholesterol and other material, called plaque, on their inner walls. This buildup is called atherosclerosis. As it grows, less blood can flow through the arteries. As a result, the heart muscle can’t get the blood or oxygen it needs. This can lead to chest pain (angina) or a heart attack. Most heart attacks happen when a blood clot suddenly cuts off the hearts’ blood supply, causing permanent heart damage. […] Over time, CAD can also weaken the heart muscle and contribute to heart failure and arrhythmias. Heart failure means the heart can’t pump blood well to the rest of the body. Arrhythmias are changes in the normal beating rhythm of the heart.

• #5 Diagnosing Coronary Artery Disease | NYU Langone Health

  https://nyulangone.org/conditions/coronary-artery-disease/diagnosis

  At NYU Langone, specialists diagnose and manage coronary artery disease, which is estimated to affect more than 13 million Americans. […] Your NYU Langone cardiologist takes a family and medical history to determine your risk for coronary artery disease. Next, he or she performs a physical exam, asks whether you smoke and how much you exercise, asks about your diet, and determines if you have diabetes, high blood pressure, or unhealthy cholesterol levels. Your doctor also orders tests to help diagnose coronary artery disease. […] Your doctor may take a sample of blood to check the levels of different substances, including cholesterol; triglycerides, or fat in the blood, which can increase the risk of coronary artery disease; proteins that can indicate inflammation in the arteries; and glucose, or sugar, which can help determine if you have diabetes. Elevated levels of these substances can increase your risk for atherosclerosis.

• #6 Heart disease – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/heart-disease/diagnosis-treatment/drc-20353124

  To diagnose heart disease, a healthcare professional examines you and listens to your heart. You are usually asked questions about your symptoms and your personal and family medical history. […] Many different tests are used to diagnose heart disease. […] Blood tests can be done to check for these proteins. A high-sensitivity C-reactive protein (CRP) test checks for a protein linked to inflammation of the arteries. Other blood tests may be done to check cholesterol and blood sugar levels. […] A Holter monitor is a portable ECG device that’s worn for a day or more to record the heart’s activity during daily activities. This test can detect irregular heartbeats that aren’t found during a regular ECG exam. […] An echocardiogram can help determine if a valve is narrowed or leaking. […] Exercise tests help reveal how the heart responds to physical activity and whether heart disease symptoms occur during exercise. […] This test can show blockages in the heart arteries. […] A cardiac MRI uses a magnetic field and computer-generated radio waves to create detailed images of the heart.

• #7 Coronary Artery Disease (CAD) > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/coronary-artery-disease

  How is coronary artery disease diagnosed? […] Doctors screen for heart disease during routine exams, asking questions about your personal and family history, taking blood samples to test cholesterol levels, and measuring your weight and blood pressure. […] If a doctor has a reason to suspect you have heart disease, he or she may order additional tests. These can include an electrocardiogram, which measures electrical activity in the heart, or a stress test, which measures how well the heart works when stressed by physical activity. […] How is coronary artery disease treated? […] Most people with coronary artery disease can be helped by one or several of three types of treatment. These are: […] Medication: Prescription drugs can counter the effects of heart disease, helping to keep risk factors including hypertension and cholesterol under control.

• #8 What Blood Tests Detect Heart Problems?

  https://my.clevelandclinic.org/health/diagnostics/16792-blood-tests-to-determine-risk-of-coronary-artery-disease

  Certain elements in your blood, like your cholesterol, triglycerides, or fibrinogen, are like a window to your heart health. Using blood tests to understand your risk of coronary artery disease is a proactive approach to a healthier heart. Work with your healthcare provider to understand your results and determine the best next steps. […] Your healthcare provider may order blood and urine lab tests to determine your risk of heart and blood vessel disease. Certain results, like high levels of low-density lipoprotein (LDL), indicate a higher risk of heart disease. The test results and your health history help your healthcare team create the best care plan for you. […] Your healthcare provider may recommend blood tests to determine your risk of heart disease such as coronary artery disease (CAD) if you:

• #9 What Blood Tests Detect Heart Problems?

  https://my.clevelandclinic.org/health/diagnostics/16792-blood-tests-to-determine-risk-of-coronary-artery-disease

  When detecting heart disease risk, healthcare providers pay close attention to: […] High levels of Lp(a) increase your risk of heart attack, stroke, blood clots, fatty buildup in veins after coronary artery bypass surgery and narrowing of coronary arteries after angioplasty. […] High levels of ApoB are a sign of small, dense LDLs. […] High levels increase your risk of heart and blood vessel disease. […] This blood test helps diagnose diabetes, which increases the risk of CAD. […] The test can indicate prediabetes and diabetes, which increase heart disease risk. […] Fibrinogen helps your blood clot, but too much increases your risk of a heart attack. […] Thyroid dysfunction is linked to heart disease and abnormal heart rhythms. […] Higher levels mean a higher risk of heart and blood vessel disease.

• #10 Coronary Heart Disease – Diagnosis | NHLBI, NIH

  https://www.nhlbi.nih.gov/health/coronary-heart-disease/diagnosis

  Your healthcare provider will diagnose coronary heart disease based on your symptoms, your medical and family history, your risk factors, and the results of heart tests. […] To help diagnose coronary heart disease, your provider may also order some of the following heart tests: […] An electrocardiogram (ECG) records the strength and timing of electrical signals as they pass through the heart and determines whether the heart’s rhythm is steady or irregular. […] A coronary calcium scan measures the amount of calcium in the walls of your coronary arteries. […] Stress tests check your heart while it is working hard and beating quickly. […] Cardiac magnetic resonance imaging (MRI) detects tissue damage or problems with blood flow in the heart or coronary arteries. […] A cardiac positron emission tomography (PET) scan assesses blood flow through the coronary blood vessels and into the heart muscle. […] Coronary CT angiography is an imaging test that looks at blood flow through the coronary arteries using a special X-ray machine that takes multiple pictures of the heart. […] Invasive coronary angiography uses contrast dye to detect blockages in the coronary arteries.

• #11 About Coronary Artery Disease (CAD) | Heart Disease | CDC

  https://www.cdc.gov/heart-disease/about/coronary-artery-disease.html

  If youre at high risk for heart disease or already have symptoms, your doctor can use several tests to diagnose CAD. […] ECG or EKG (electrocardiogram) measures the electrical activity, rate, and regularity of your heartbeat. […] Echocardiogram uses ultrasound (special sound wave) to create a picture of the heart. […] Exercise stress test measures your heart rate while you walk on a treadmill. This helps to determine how well your heart is working when it has to pump more blood. […] Chest X-ray uses x-rays to create a picture of the heart, lungs, and other organs in the chest. […] Cardiac catheterization checks the inside of your arteries for blockage by inserting a thin, flexible tube through an artery in the groin, arm, or neck to reach the heart. Health care professionals can measure blood pressure within the heart and the strength of blood flow through the hearts chambers as well as collect blood samples from the heart or inject dye into the arteries of the heart (coronary arteries). […] Coronary angiogram monitors blockage and flow of blood through the coronary arteries. Uses X-rays to detect dye injected via cardiac catheterization. […] Coronary artery calcium scan is a computed tomography (CT) scan that looks in the coronary arteries for calcium buildup and plaque.

• #12 Coronary Artery Disease | Conditions | UCSF Health

  https://www.ucsfhealth.org/conditions/coronary-artery-disease

  Echocardiogram (ECHO). Sometimes referred to as a heart ultrasound, this noninvasive test uses sound waves to create pictures of your heart. It provides information about how the heart is pumping, how blood flows through the heart and blood vessels, how the valves are working, and the size of the heart. […] Electrocardiogram (ECG or EKG). An ECG records the heart’s electrical activity using small electrodes that are placed with patches on your chest, arms and legs. The electrodes are connected by wires to a machine that records the flow patterns of electrical current in the heart. The test is used to diagnose arrhythmias and detect signs of heart damage. […] Exercise stress test. Also called a stress echocardiogram, this test shows how your heart performs when physically challenged. You’ll exercise on a treadmill (or possibly a bicycle) while wearing ECG electrodes and wires so that your heart’s electrical signals can be recorded.

• #12 Coronary Artery Disease | Conditions | UCSF Health

  https://www.ucsfhealth.org/conditions/coronary-artery-disease

  Nuclear stress test. Also known as a stress thallium test, this has two components, a treadmill stress test and a heart scan. First, a small amount of a harmless radioactive substance (hence the term nuclear) is injected into a vein. By tracking the substance with a special camera, doctors can view the coronary arteries, the heart’s shape and function, and how blood flows through this system. This type of test has been used for many years to evaluate how much blood the heart is getting under various conditions, such as during exercise.

• #12 Coronary Artery Disease | Conditions | UCSF Health

  https://www.ucsfhealth.org/conditions/coronary-artery-disease

  Doctors assess patients by looking for atherosclerosis, which can be detected using various tests, including: […] Coronary angiography. This minimally invasive study is considered the gold standard for diagnosing CAD. Sometimes performed via cardiac catheterization (using a thin, flexible tube called a catheter to reach the heart), it can show whether the heart’s blood vessels have narrowed, whether blood flow and the heart’s pumping function are normal, and whether the heart’s valves are working properly. It also can identify heart abnormalities that some people are born with. […] Computed tomography (CT) scan. This can show calcium deposits and blockages that are narrowing the arteries. To better reveal the location of the problems, a harmless dye that shows up on X-rays may be injected into a vein.

• #13 Coronary Artery: Risk Factors, Diagnosis & Treatment

  https://bluenethospitals.com/health-library/coronary-artery-disease

  When you have two or more risk factors, your risk of coronary artery disease is higher. If you know or feel that you have any of these symptoms or risk factors, do not hesitate to discuss them with your Cardiologist. He/she will most likely recommend you undergo some tests to detect or discard Coronary Artery Disease. […] There is no unique test to diagnose Coronary artery disease because several factors play a role. Your Cardiologist will likely perform a physical exam, listen to your heart, and ask you some questions about your lifestyle, family history, and medical conditions that will determine if there is a need to order more tests to detect or rule out Coronary Artery Disease. […] Some of the most common studies are: Electrocardiogram: It records the electrical activity and rhythm of the heart; an EKG may reveal evidence of a previous or ongoing heart attack. Holter monitor: A portable device is placed under your clothing for 12 days to monitor your heart’s activity while you go about your daily activities. Stress test analyzes how the heart works before and after a physical effort. The Cardiologist will put you on a treadmill or stationary bike or give you some heart-boosting medication. Blood tests: Usually used to measure and monitor blood cholesterol levels. Echocardiogram: An echocardiogram determines if all heart parts naturally contribute to the heart’s blood and oxygen pumping by using sound waves to produce images of the heart organ.

• #14 Stress testing for the diagnosis of obstructive coronary artery disease – UpToDate

  https://www.uptodate.com/contents/stress-testing-for-the-diagnosis-of-obstructive-coronary-artery-disease/print

  Stress testing for the diagnosis of obstructive coronary artery disease […] The diagnosis of coronary artery disease (CAD) as the cause of chest discomfort (or other anginal-type symptoms of cardiac origin) starts with a careful clinical history and resting electrocardiogram (ECG), and often requires additional investigation. […] The evaluation of patients presenting with chest discomfort or other symptoms suggestive of CAD often relies upon stress testing. […] The use of stress testing for the diagnosis of obstructive CAD will be reviewed here. […] Our approach to diagnostic stress testing varies with the pretest probability of disease, which is the estimate of the likelihood of CAD prior to stress testing based upon the patient’s age, gender, symptom characteristics, and clinical history, including standard cardiac risk factors. […] This estimate of pretest probability of CAD can then be used to determine the need for and the optimal initial diagnostic approach to testing in the patient with known or suspected CAD.

• #15 Coronary Artery Disease Testing | National Jewish Health

  https://www.nationaljewish.org/conditions/cad/diagnosis

  Often, symptoms bring a person in to see a cardiologist. The cardiologist will take into account several factors in diagnosing coronary artery disease (CAD), such as family history, symptoms, and risk factors. In addition, there are several diagnostic tests that are helpful when used together to diagnose the condition. […] In a stress test, you perform a physical activity, such as jogging on a treadmill, to increase the speed of your heartbeat. This helps determine how well your heart performs. Usually, the stress test is accompanied by either nuclear or echocardiographic imaging. […] An echocardiogram uses sound waves to produce an image of the heart, showing how well it is working. It can help determine which areas of the heart are having problems and help identify any damage to the heart.

• #16 Coronary Artery Disease-Symptoms, Diagnosis, Treatment | AHN

  https://www.ahn.org/services/cardiovascular/conditions/coronary-artery-disease

  The Allegheny Health Network (AHN) Cardiovascular Institute is a national leader in using advanced diagnostic technology and minimally invasive procedures to diagnose and treat heart disease. […] Our physicians use the latest imaging methods to determine the cause, severity, and prognosis of your heart condition. You may undergo one or more of these coronary artery disease tests: […] This noninvasive test assesses your hearts electrical activity. […] A stress test assesses changes in your heart during exertion compared with rest. A nuclear stress test, or single photon emission computed tomography (SPECT), uses injectable radioactive tracers to show blood flow to the heart during exertion and rest. […] This ultrasound test uses high-frequency sound waves to produce real-time images of the heart and its pumping action.

• #16 Coronary Artery Disease-Symptoms, Diagnosis, Treatment | AHN

  https://www.ahn.org/services/cardiovascular/conditions/coronary-artery-disease

  This heart scan uses an injectable radioactive substance called a tracer to display blood flow to your heart and check for blockages. […] A series of X-rays taken from different angles after injection of contrast dye into a vein in the arm produce detailed images of the heart arteries. […] This cardiac imaging scan uses strong magnets to create detailed images of the heart in motion. […] Your physician threads a long, thin tube (catheter) to the heart and uses contrast dye to locate blockages. […] This test uses a small ultrasound wand attached to a catheter to capture images from inside the blood vessels.

• #17 Coronary Artery Disease | Diagnosis

  https://healthlibrary.uhc.com/content/healthlibrary/uhc/hl/health-topics/CAD/the_basics/0012-3C-diagnosing-cad.html

  An exercise EKG, or stress test, is usually done while you’re actively moving on a treadmill. It can show whether your heart is getting enough oxygen-rich blood to work properly while active. […] Echocardiography. This test is a type of ultrasound. It uses high-frequency sound waves to make a moving picture of your heart. […] Your doctor may recommend a coronary angiogram if the previous tests or other factors indicate CAD is likely. This test examines the insides of your coronary arteries. […] Special X-rays are taken while the dye is flowing through your coronary arteries. Your doctor will be able to study the arteries’ blood flow and see any narrow areas or blockages.

• #18

  https://www.mountelizabeth.com.sg/conditions-diseases/coronary-artery-disease/diagnosis-treatment

  How is coronary artery disease diagnosed? Your doctor will ask about your family and medical history and determine your risk factors. Your doctor may also recommend the following tests: […] Electrocardiogram (ECG). Records your heart’s electrical activity through electrodes (small, plastic patches that stick to the skin). […] Exercise stress test. Involves running or walking on a treadmill to determine how well your heart responds during exertion. […] Blood test. Checks your levels of cholesterol, triglycerides, sugar and other risk factors of coronary artery disease. […] Cardiac magnetic resonance imaging (cardiac MRI). A non-invasive procedure that uses magnets and radio waves to produce detailed images of your heart. […] Coronary calcium scan. A computed tomography (CT) scan that measures the build-up of calcium in coronary arteries.

• #19 A safer way to diagnose coronary artery disease? – Harvard Health

  https://www.health.harvard.edu/heart-health/a-safer-way-to-diagnose-coronary-artery-disease

  Cardiac CT angiography a noninvasive test to check for clogged heart arteries is now considered a first-line option for people with suspected heart disease. […] The second, cardiac CT angiography (CCTA), was developed nearly 25 years ago. This test doesn’t require a catheter; rather, the special dye is injected into a vein in the arm or hand. Instead of the standard x-rays used in ICA, the newer test uses a CT scanner, which takes multiple, rapid x-rays that are merged together to create a detailed, three-dimensional view of the heart’s arteries. […] Last year, expert guidelines from the American Heart Association and American College of Cardiology recommended CCTA as a first test for certain people without known coronary artery disease who have stable angina (transient chest pain that occurs predictably during activity or emotional stress).

• #20 Coronary Artery Disease: How This Is Diagnosed

  https://www.healthline.com/health/how-is-coronary-artery-disease-diagnosed

  Coronary artery disease (CAD) may go overlooked until someone has a heart attack. Imaging tests, like coronary angiograms, can be used to diagnose CAD. […] For anyone with risk factors or early symptoms of CAD, blood tests and medical imaging can be used to diagnose the condition before a heart attack or heart failure occurs. […] When warning signs and symptoms of CAD are present, your doctor will typically request blood tests and medical imaging of the heart and blood vessels to get a diagnosis. These tests allow healthcare professionals to get a better idea of the hearts structure and function, as well as evidence of where any blockages may be. […] A wide range of tests can be used to detect coronary artery disease. […] If you have risk factors or symptoms of CAD, your doctor may recommend one or several of the following: coronary angiogram, coronary artery calcium scan, cardiac catheterization, echocardiogram, electrocardiogram (EKG/ECG), exercise stress test, chest X-ray.

• #21 Coronary artery disease diagnostics: A precision or functional approach? | Valley Health System

  https://www.valleyhealth.com/trending/coronary-artery-disease-diagnostics-precision-or-functional-approach

  Coronary artery disease (CAD) is the most common type of heart disease in the United States as noted by the Centers for Disease Control and Prevention. This condition is commonly detected through imaging after a patient expresses symptoms of chest pain or shortness of breath. In severe cases, the first sign of CAD is a heart attack. […] The findings from the PRECISE trial highlight the Precision strategy as the preferred diagnostic strategy when evaluating patients with stable chest pain and suspected coronary artery disease. […] At The Valley Heart and Vascular Institute, our Advanced Cardiovascular Imaging team is using the latest computed tomography (CT) technologies, including HeartFlow Analysis to perform a physiological assessment of coronary artery blockages in select patients. HeartFlow Analysis creates a digital 3D rendering of the patients coronary arteries and uses powerful computer algorithms to simulate blood flow to assess the impact of blockages. This approach allows for appropriate use of interventional procedures. Our interventional cardiologists use this technique to guide their invasive management, as it provides a clearer understanding of coronary artery disease, improves patient safety and outcomes, and reduces procedural duration.

• #22 Heartflow – Decisive Coronary Care

  https://www.heartflow.com/

  Heartflow’s vision is to transform CAD from the leading cause of death into a disease that can be managed for life. Our first-of-its-kind AI analysis creates a detailed 3D model of the heart – a window into your patient’s future, empowering you with insights to personalize each treatment journey. […] Conventional diagnostic methods frequently provide misleading information that can result in undiagnosed disease, unnecessary procedures, incorrect treatment plans, poor patient experience, and increased cost to healthcare systems. […] 20-30% False Negatives that lead to undetected diseases 55% False Positives that lead to unnecessary procedures […] Coronary CTA (CCTA) + Heartflow reveals clear pathways for your patients. With Heartflow, a CCTA scan is transformed into a dynamic and personalized 3D model of the heart, assessing anatomy and physiology. Providing clarity and confidence with better disease insights to ensure your next decision is the right one for your patients.

• #23 Technique Improves Coronary Artery Disease Diagnosis

  https://newsroom.uvahealth.com/2024/11/19/technique-improves-coronary-artery-disease-diagnosis/

  Coronary artery disease is the most common form of heart disease, affecting 70% or more of people over 60. […] A new technology which allows doctors to quantify blood flow in the heart can improve their ability to diagnose potentially deadly coronary artery disease (CAD), an international study led by School of Medicine investigators has found. […] The technique represents an advance in cardiac magnetic resonance imaging (CMR) used in conjunction with stress testing to diagnose coronary artery disease, a condition which affects 70% or more of people over 60. […] CMR stress testing is a useful way to spot coronary artery disease, but the new research from Patel and colleagues suggests that quantitative CMR with blood-flow data is even better. […] The researchers found that adding data on blood flow significantly improved CMRs ability to identify obstructive coronary artery disease.

• #24 7 Critical Insights Into Coronary Artery Disease and How to Prevent It – UDS

  https://udshealth.com/blog/coronary-artery-disease-causes-diagnosis-treatment/

  Coronary artery disease can remain asymptomatic for years until it presents as angina or a heart attack. Symptom recognition is crucial for timely intervention. […] Early and accurate diagnosis of CAD is essential for preventing acute events and initiating appropriate therapy. Modern diagnostics combine clinical evaluation with advanced imaging and stress testing. […] Recent innovations, such as quantitative perfusion cardiac magnetic resonance imaging (qCMR) and FFR-CT (fractional flow reserve computed tomography), provide improved accuracy in identifying functionally significant lesions. […] The management of coronary artery disease is tailored to the severity of the disease, symptom burden, and the presence of comorbid conditions. Treatment generally falls into three major categories: lifestyle modification, pharmacologic therapy, and revascularization procedures.

• #25 Coronary Artery Disease (CAD) Symptoms and Diagnosis at Emory Heart & Vascular

  https://www.emoryhealthcare.org/services/heart-vascular/conditions/coronary-artery-disease

  Diagnosing Coronary Artery Disease […] To diagnose CAD, your doctor will ask about your medical history and perform a physical exam. Your doctor may also order other diagnostic tests, including: […] A PET scan is one of the most common tests doctors use to diagnose CAD. PET scans produce detailed images of your heart’s blood flow and function. […] During a PET scan, a technician injects a small amount of radioactive tracer into your bloodstream. This tracer highlights blockages or abnormalities in the coronary arteries.

• #26 Coronary Artery Disease Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/349040-overview

  MRI has proved capable of imaging the coronary arteries and revealing stenoses without catheterization or injection of contrast material. […] Advances in MRI and CT have markedly improved the speed and resolution of imaging, making these modalities useful in the clinical evaluation of CAD, while improving their safety and convenience. […] Although neither MRI nor CT has replaced coronary angiography (XRA) as the clinical standard for diagnosis of coronary stenosis, their use in determining whether a vessel is open is increasing. […] The extent of impairment or damage caused by stenosis obstructing a coronary artery depends on how much of the myocardium the vessel supplies, the severity of stenosis and of any superimposed spasm, and the level of demand and the condition of tissue supplied by the vessel.

• #27 Coronary artery disease – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/coronary-artery-disease/

  Resting ECG: indicated for all patients. […] Either cardiac stress testing or CCTA can be used to risk stratify patients with intermediate to high PTP of obstructive CAD. […] Additional diagnostic testing is not routinely recommended for patients with a low pretest probability of obstructive CAD. […] Resting ECG results are usually normal in patients with stable CAD. […] The 2021 AHA chest pain guidelines recommend using validated scores published within the past 10 years to predict the pretest probability of obstructive CAD. […] Patients with obvious noncardiac chest pain and reassuring ECG do not require cardiac testing or calculation of pretest probability of CAD. […] Coronary CT angiography (CCTA): can visualize anatomic CAD. […] Coronary angiography: Indications include chronic stable angina, high clinical suspicion for CAD and ambiguous results on noninvasive testing, and persistent symptoms of angina despite appropriate therapy. […] Patients with acute chest pain and other concerning clinical findings (e.g., hypotension) or ECG changes that are suggestive of acute coronary syndrome (e.g., new heart blocks or arrhythmias) should undergo cardiac catheterization.

• #28 Evolving Diagnostic and Management Advances in Coronary Heart Disease

  https://www.mdpi.com/2075-1729/13/4/951

  Finally, biomarkers have been investigated to aid with CAD detection. Circulating microRNAs have been proposed as a potential target in this context. […] Below, some of the aforementioned methods are discussed in more detail. […] Intravascular ultrasonography (IVUS) has played an important role in recent interventional evolution. It enables not only the anatomical evaluation of lesion severity and plaque morphology but also better stent deployment and intrastent obstruction evaluation. […] The assessment of the minimal lumen area (MLA) by intravascular imaging could be a surrogate for ischemia evaluation. […] Fractional flow reserve (FFR) is an invasive index of the functional severity of stenosis determined from coronary pressure measurement during cardiac catheterization. […] In summary, FFR appears to be a safe method to determine which lesions do not warrant treatment in addition to visual analysis. However, what it represents in terms of clinical value is still debated.

• #28 Evolving Diagnostic and Management Advances in Coronary Heart Disease

  https://www.mdpi.com/2075-1729/13/4/951

  Despite some degree of controversy, FFR has been implemented in clinical practice for the evaluation of stable CAD. […] In conclusion, CCTA-FFR apparently has a high accuracy when FFR is used as the gold standard, adding discriminative power to CT alone and reducing false-positive findings by associating a functional evaluation with this anatomical method.

• #28 Evolving Diagnostic and Management Advances in Coronary Heart Disease

  https://www.mdpi.com/2075-1729/13/4/951

  CAD may be assessed via anatomical or functional methods. The first relies on observing the disease by detecting physical obstruction to blood flow. The key to anatomical methods is coronary angiography, which delineates coronary anatomy using contrast media and radiation. […] More recently, plaque evaluation technology has been developed, and near-infrared spectroscopy (NIRS) is a novel technique in this area. […] The physiological assessment of CAD allows complementing the findings of the anatomical evaluation. Probably the most widespread physiological assessment method is the exercise electrocardiogram (ECG). […] As such, SPECT and CMR stress-perfusion have become methods used almost worldwide for noninvasive functional evaluation, allowing the characterization of specific ischemic myocardial segments, especially for individuals with suspected CAD with intermediate risk probability.

• #29 Diagnostic Tests for Non-Obstructive Coronary Artery Disease | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/blood-heart-circulation/non-obstructive-coronary-artery-disease/diagnosis.html

  When caring for symptoms like chest pain, our doctors know when to look beyond the blocked arteries that define obstructive coronary artery disease (CAD). […] This less common form of CAD occurs when your hearts arteries inappropriately constrict, malfunction after branching into tiny vessels, or are squeezed by the overlying heart muscle. […] Our doctors lead the way in providing answers through ongoing research to improve diagnosis and treatment. […] Advanced diagnostic testing for those with chest pain but no blockages, including testing for endothelial dysfunction, microvascular dysfunction, and myocardial bridging. […] Diagnosing non-obstructive coronary disease depends on highly specialized tests performed during a cardiac catheterization. […] Prior to cardiac catheterization, our team evaluates your risk factors, takes a medical history, and gives a physical exam to understand a full picture of your health.

• #30 Diagnosis of patients with angina and non-obstructive coronary disease in the catheter laboratory | Heart

  https://heart.bmj.com/content/105/20/1536

  Around 40% of all patients undergoing angiography are found to have normal coronary arteries or non-obstructive coronary artery disease (NOCAD). […] Despite the high prevalence, this is a group who rarely receive a definitive diagnosis, are frequently labelled and managed inappropriately and by and large, continue to remain symptomatic. […] Half of this group will have coronary microvascular dysfunction (CMD), associated with a higher rate of major adverse cardiovascular events; identifying CMD represents a therapeutic target of unmet need. […] The standard of care for investigating stable angina in patients with an intermediate-high likelihood of coronary artery disease (CAD) is the coronary angiogram. […] In a registry of nearly 400000 patients undergoing invasive coronary angiography, approximately 40% had Non-Obstructive Coronary Artery Disease, a diagnosis often referred to as NOCAD.

• #30 Diagnosis of patients with angina and non-obstructive coronary disease in the catheter laboratory | Heart

  https://heart.bmj.com/content/105/20/1536

  NOCAD is associated with worse healthcare outcomes and higher economical costs than previously appreciated. […] Traditional atherosclerotic risk factors and typicality of angina are poor predictors of CMD, necessitating objective tests to establish a clinical diagnosis; however, tests of coronary microvascular function are rarely used in clinical practice. […] The ability to physiologically characterise CAD at the time of angiography by pressure-wire assessment has revolutionised the interventional cardiology field. […] Advances in guidewire technology now also enable the immediate assessment of the coronary microcirculation to provide clarity into the NOCAD diagnosis. […] CMD can be identified during a single cardiac catheterisation procedure, overcoming issues of specificity and sensitivity associated with non-invasive ischaemia tests.

• #31 Coronary artery disease – Wikipedia

  https://en.wikipedia.org/wiki/Coronary_artery_disease

  Coronary artery disease is characterized by heart problems that result from atherosclerosis. A number of tests may help with diagnosis including electrocardiogram, cardiac stress testing, coronary computed tomographic angiography, biomarkers (high-sensitivity cardiac troponins) and coronary angiogram, among others. The diagnosis of CAD depends largely on the nature of the symptoms and imaging. The first investigation when CAD is suspected is an electrocardiogram (ECG/EKG), both for stable angina and acute coronary syndrome. For stable symptomatic patients, several non-invasive tests can diagnose CAD depending on pre-assessment of the risk profile. Noninvasive imaging options include; Computed tomography angiography (CTA) (anatomical imaging, best test in patients with low-risk profile to „rule out” the disease), positron emission tomography (PET), single-photon emission computed tomography (SPECT)/nuclear stress test/myocardial scintigraphy and stress echocardiography (the three latter can be summarized as functional noninvasive methods and are typically better to „rule in”). Invasive testing with coronary angiography (ICA) can be used when non-invasive testing is inconclusive or show a high event risk. The diagnosis of microvascular angina (previously known as cardiac syndrome X) is a diagnosis of exclusion.

• #32 Enhancing the diagnosis of functionally relevant coronary artery disease with machine learning | Nature Communications

  https://www.nature.com/articles/s41467-024-49390-y

  Functionally relevant coronary artery disease (fCAD) can result in premature death or nonfatal acute myocardial infarction. Its early detection is a fundamentally important task in medicine. Classical detection approaches suffer from limited diagnostic accuracy or expose patients to possibly harmful radiation. Here we show how machine learning (ML) can outperform cardiologists in predicting the presence of stress-induced fCAD in terms of area under the receiver operating characteristic (AUROC: 0.71 vs. 0.64, p=4.0E-13). We present two ML approaches, the first using eight static clinical variables, whereas the second leverages electrocardiogram signals from exercise stress testing. At a target post-test probability for fCAD of 15%, ML facilitates a potential reduction of imaging procedures by 15-17% compared to the cardiologists judgement. Predictive performance is validated on an internal temporal data split as well as externally. We also show that combining clinical judgement with conventional ML and deep learning using logistic regression results in a mean AUROC of 0.74.

• #32 Enhancing the diagnosis of functionally relevant coronary artery disease with machine learning | Nature Communications

  https://www.nature.com/articles/s41467-024-49390-y

  Evaluating CARPEECG as a predictive model on all patients of the held-out test set (at the 15% decision threshold) shows the potential to reduce perfusion imaging by 15.3% without increasing the rate of false negatives. This number increases to 17.3% when using CARPEColl. We observe similar behaviour in patients without a CAD history. […] Overall, the discriminative performance was highest in younger patients (CARPEECG AUROC: 0.78) in general and in younger patients who did not require pharmacological support specifically (CARPEECG AUROC: 0.79). The former cohort also represents the stratum in which the increase over the cardiologist is the highest, namely 0.19 in AUROC and 0.15 in AUPRC. […] We derived and validated two ML models for the safe risk-stratification of patients with suspected fCAD. The models were developed using basic clinical information and raw stress test ECG signals. Their performance was compared to a numerical risk estimate by the treating cardiologist after stress testing. Justified by their good predictive performance, we find both models to potentially be useful risk-stratification tools for the primary care setting where cardiac stress testing is not always performed but there is access to the relevant clinical information and for the secondary and tertiary setting where stress testing is performed and relevant clinical information is available. Both ensemble learning based on basic clinical information and deep learning based on clinical information and stress ECG signals outperformed the cardiologists numerical risk assessment after stress testing as well as currently employed risk scores in predicting the presence of fCAD.

• #33 Clinical features and diagnosis of coronary heart disease in women – UpToDate

  https://www.uptodate.com/contents/clinical-features-and-diagnosis-of-coronary-heart-disease-in-women

  There are significant differences between men and women in the epidemiology, diagnosis, treatment, and prognosis of coronary heart disease (CHD). These should be taken into account in the care of women with known or suspected disease. […] The clinical features and diagnosis of CHD in women will be reviewed here. […] Myocardial infarction (MI) associated with nonobstructive coronary artery disease is discussed separately. Ischemia due to nonobstructive coronary artery disease, including microvascular angina and vasospasm, is discussed separately.

• #34 Coronary Function Testing Provides Greater Diagnostic Resolution for Women with Heart Disease < Yale School of Medicine

  https://medicine.yale.edu/news-article/coronary-function-testing-provides-greater-diagnostic-resolution-for-women-with-heart-disease/

  Ischemic heart disease remains a leading cause of morbidity and mortality in women. […] This study, led by Samit Shah, MD, PhD, assistant professor of medicine (cardiovascular medicine), examined the diagnoses given to women with suspected ischemic heart disease who underwent routine care compared to advanced diagnostic testing, referred to as coronary function testing. […] The researchers found that women who solely underwent coronary angiography were more likely to receive a rudimentary description of the blood vessels, such as normal blood vessels or non-significant coronary artery disease. However, those who underwent combined coronary angiography with coronary function testing were more likely to receive a specific diagnosis such as coronary microvascular dysfunction, coronary vasospasm, myocardial bridging, or other diagnosis.

• #34 Coronary Function Testing Provides Greater Diagnostic Resolution for Women with Heart Disease < Yale School of Medicine

  https://medicine.yale.edu/news-article/coronary-function-testing-provides-greater-diagnostic-resolution-for-women-with-heart-disease/

  This study illuminates the utility of coronary function testing in women with suspected ischemic heart disease and ANOCA. The authors anticipate that increased use of coronary function testing will lead to more specific treatments for stable ischemic heart disease, which remains a leading cause of morbidity and mortality in women.

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