Myocardial perfusion

You can use myocardial perfusion imaging with a treadmill stress test and that will give you very important information. It will tell you how in shape this patient is.

Do they have ST changes at 12 minutes or do they have them at 2 minutes? Having them at 2 minutes is a risk factor in itself even if we don’t ever document ischemia on our images. On the other hand, you can also use adenosine or pharmacologic stress. Often these patients have concurrent asthma, COPD or peripheral vascular disease that prevents them from exercising adequately. Remember, you always need to check and make sure the patient had adequate exercise prior to interpreting the perfusion imaging.
Sort of the next step down, I think, possibly some family practitioners will and some people will not still be seeing this level of patient. These are patients who already have known coronary disease and who have recurrent chest pain. Remember, you can still have gastroesophageal reflux disease or PE in somebody who has coronary artery disease.

Risk stratification after acute MI. Again, some family practitioners are going to be caring for these patients. Others will have already referred the patient off to a cardiologist but there are a number of ways in which this study can help you in the post myocardial infarction patient. In those patients who have no ischemia on this study, less than 1% will have a coronary event in the next one year. That is excellent prognostic information. It can make everybody feel a lot more comfortable that there is no significant ischemia that needs to be treated aggressively at this time.

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