Stress Examinations The objective of stress testing is typically to evaluate the extent and adequacy of the hyperemic response, thereby assessing the ability of the coronary circulation to augment flow to meet increasing work demand (ie, coronary flow reserve) [35]. When used in combination with imaging, depending on the degree and duration of induced ischemia, stress testing elicits and evaluates the ischemic endpoints that relate to coronary supply or demand imbalance characteristic of CAD. This ischemic cascade includes sequential abnormalities in the following order: perfusion, myocardial stiffening, wall motion abnormalities, electrocardiographic stress test segment changes, and chest pain. When appropriate, exercise-based stress testing is preferred to pharmacologically induced stress testing; unfortunately, it is impractical in many imaging environments, moreover for patients unable to adequately exercise [35]. Thus, the pharmacologic stress perfusion endpoint (achieved with a coronary artery dilating agent, such as adenosine or regadenoson) of induced coronary flow heterogeneity is used with the various forms of MPI; the functional ischemic endpoint (achieved with a myocardial inotropic agent, such as dobutamine) of induced wall motion abnormalities is detected and monitored during dynamic myocardial contraction imaging. Discussion of Procedures by Variant Prompt evidence-based diagnosis and treatment of new-onset nonacute HF may help decrease hospital stay, costs related to treatment, and mortality. Unfortunately, the accurate diagnosis of HF in the primary care setting is difficult and partly related to frequent suboptimal access to, and use of, cardiac imaging [36]. Variant 1: Suspected new-onset nonacute heart failure, not previously diagnosed. Initial imaging. Radiography Chest Historically, chest radiograph has been commonly used in the assessment of patients with suspected new-onset HF in the outpatient setting.
Suspected New Onset and Known Nonacute Heart Failure. Stress Examinations The objective of stress testing is typically to evaluate the extent and adequacy of the hyperemic response, thereby assessing the ability of the coronary circulation to augment flow to meet increasing work demand (ie, coronary flow reserve) [35]. When used in combination with imaging, depending on the degree and duration of induced ischemia, stress testing elicits and evaluates the ischemic endpoints that relate to coronary supply or demand imbalance characteristic of CAD. This ischemic cascade includes sequential abnormalities in the following order: perfusion, myocardial stiffening, wall motion abnormalities, electrocardiographic stress test segment changes, and chest pain. When appropriate, exercise-based stress testing is preferred to pharmacologically induced stress testing; unfortunately, it is impractical in many imaging environments, moreover for patients unable to adequately exercise [35]. Thus, the pharmacologic stress perfusion endpoint (achieved with a coronary artery dilating agent, such as adenosine or regadenoson) of induced coronary flow heterogeneity is used with the various forms of MPI; the functional ischemic endpoint (achieved with a myocardial inotropic agent, such as dobutamine) of induced wall motion abnormalities is detected and monitored during dynamic myocardial contraction imaging. Discussion of Procedures by Variant Prompt evidence-based diagnosis and treatment of new-onset nonacute HF may help decrease hospital stay, costs related to treatment, and mortality. Unfortunately, the accurate diagnosis of HF in the primary care setting is difficult and partly related to frequent suboptimal access to, and use of, cardiac imaging [36]. Variant 1: Suspected new-onset nonacute heart failure, not previously diagnosed. Initial imaging. Radiography Chest Historically, chest radiograph has been commonly used in the assessment of patients with suspected new-onset HF in the outpatient setting.