Prognosis in medically stabilized unstable angina: early Holter ST-segment monitoring compared with predischarge exercise thallium tomography

Article Abstract:

Angina (cardiac chest pain) can be classified as stable or unstable. Unstable angina occurs with little or no exertion and with increasing frequency. Because unstable angina carries a relatively high risk of heart attack (myocardial infarction) and death, efforts have been made to find the most clinically useful tests to identify patients at greatest risk. Current strategies include 24-hour electrocardiogram (Holter) monitoring, standard stress testing, exercise testing with nuclear imaging, and coronary angiograms. Fifty-four patients with unstable angina, who were admitted to a coronary care unit, were studied with 24-hour electrocardiograms immediately on admission, and were stabilized with anti-anginal medications. When the patients were pain-free for 24 hours, they underwent routine exercise stress testing and nuclear stress testing. In the latter, thallium is injected during maximal exercise and special photographic images are taken of the heart that outline areas of muscle receiving inadequate oxygen supplies during exercise. Holter monitoring was not predictive of future adverse cardiac events, and routine stress tests were similarly unhelpful in predicting future risks. However, thallium stress tests were more useful. Thallium studies were even more accurate than coronary angiograms in identifying patients with unstable angina who were likely to have adverse cardiac events, such as myocardial infarction or even death. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Prognosis, Tomography, Thallium

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Implications and challenges using practice guidelines for chronic angina

Article Abstract:

Practice guidelines can help bring medical care in line with public health goals. These guidelines contain the best treatments for a particular disease or medical condition, based on scientific evidence. There are approximately 25 guidelines for heart diseases, including angina pectoris.

Care and treatment, Editorial

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Computer systems to help with ordering blood tests in primary care

Article Abstract:

A computer system that links a patient's medical records to a database of practice guidelines can reduce the number of unnecessary blood tests. The practice guidelines specific which tests should be ordered, depending on the patient's symptoms.

Evaluation, Medical tests, Decision support systems

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