Oxford Handbook of Cardiology 2nd Edition
A commonly used test involving a treadmill, blood pressure (BP) measurement, and continuous electrocardiograph (ECG) monitoring. Overall sensitivity for coronary heart disease is around 68 % and specifi city is 77 % .
This increases when considering prognostically signifi cant disease, which has a sensitivity of 86 % . The test improves to have a predictive accuracy of > 90 % in intermediate- to high-risk patients (older men with ischaemic symptoms). The test is of least value in populations that are least likely to be suffering from ischaemic heart disease; e.g. asymptomatic middle-aged women have a positive predictive value of <50 % .
• Diagnosis of ischaemic heart disease (IHD): intermediate- or high-probability IHD, vasospastic angina.
• Post-myocardial infarction (MI): pre-discharge (submaximal test in days 4–7 to assess prognosis, decide upon exercise programme, and evaluate treatment), late post-discharge (symptom-limited 3–6 weeks).
• Pre- and post-revascularization.
• Evaluation of arrhythmias: optimizing rate-responsive pacemaker function, evaluation of known or suspected exercise-induced arrhythmias, and evaluation of treatment of above.
• Fever/acute viral illness.
• Severe aortic stenosis.
• Aortic dissection.
• Uncontrolled hypertension.
• Overt cardiac failure.
• Unstable angina or acute phase of MI.
• Signifi cant resting arrhythmia (e.g. uncontrolled atrial fi brillation or
complete heart block).
• Known severe left main stem (LMS) or LMS equivalent disease.
• Physical disability.
• ECG abnormality rendering interpretation of ST segment diffi cult (e.g. left bundle branch block (LBBB), left ventricular hyphetrophy (LVH) with strain or digoxin ECG changes).
Symbols and abbreviations ix
1 Cardiac investigations 1
2 Drugs for the heart 81
3 Valvular heart disease 143
4 Infective endocarditis 187
5 Coronary artery disease 211
6 Cardiac catheterization and intervention 309
7 Heart failure 367
8 Heart muscle diseases 417
9 Pericardial diseases 459
10 Arrhythmias 477
11 Invasive electrophysiology 541
12 Congenital heart disease 589
13 Multisystem disorders 617
14 Cardiovascular disease in less-developed
15 Heart disease in pregnancy 673
16 Eponymous syndromes 697
17 Cardiovascular emergencies 709
18 Practical procedures 783
Appendix: Clinical trials 831
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