What Is the Overall Management of Coronary Artery Disease—That Is, in What Context Should Coronary Artery Surgery Be Considered?
Coronary heart disease may be recognized by the physician as the clinical syndromes of angina pectoris, acute myocardial infarction, sudden cardiac arrest, or ischemic cardiomyopathy. It may also be recognized in an asymptomatic form by detection of electrocardiographic evidence of prior myocardial infarction not recognized during the acute episode or by characteristic abnormalities of the electrocardiogram during exercise testing of apparently healthy persons. Once suspected by the physician, the diagnosis may be confirmed with various levels of certainty by one or more special diagnostic tests. The tests most commonly used include the electrocardiogram recorded during and after monitored graded exercise, in some institutions radionuclide studies of myocardial perfusion and ventricular function at rest and in response to exercise, and coronary arteriography with left ventricular angiography. In addition to confirming the diagnosis, such studies may provide information about the pathol
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