SUMMARYStable angina pectoris is characterised by typical exertional chest pain that is relieved by rest or nitrates.Risk stratification of patients is important to define prognosis, to guide medical management and to select patients suitable for revascularisation.Medical treatment aims to relieve angina and prevent cardiovascular events. Beta blockers and calcium channel antagonists are first-line options for treatment. Short-acting nitrates can be used for symptom relief.Low-dose aspirin and statins are prescribed to prevent cardiovascular events.
Clinical evaluationThe history, examination, ECG and laboratory tests provide important prognostic information. Increasing age, chronic kidney disease, diabetes, hypertension, current smoking, previous myocardial infarction, hypercholesterolaemia and heart failure are predictive of adverse outcomes.
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EchocardiographyEchocardiography provides information about left ventricular function, and regional wall motion abnormalities that may be related to infarction or ischaemia. In patients with stable coronary artery disease, left ventricular ejection fraction is the strongest predictor of long-term survival. The 12-year survival of medically treated patients with ejection fractions greater than 50% is 73%, and 54% if the ejection fraction is between 35% and 49%. Survival is only 21% if the ejection fraction is less than 35%.
knee with tibial-femoral dislocation documented by physical examination and MRI.There were 72 knee injuries involving multiple ligaments. In these 72 injured extremities, 12 vascular injuries were identified. Four of these were identified by physical examination and 5 by routine arteriography. There were 3 additional vascular injuries not identified by either preoperative physical examination or arteriography. In the 4 patients who had an abnormal physical examination at presentation, all underwent immediate revascularization. The remaining 8 patients had normal pulses on initial examination. All underwent arteriography and 5 had vascular injuries detected by arteriography and underwent successful repair. There were 3 patients who had a normal physical examination and an arteriogram interpreted as normal but who subsequently proved to have a popliteal artery injury. Two of the 3 patients who had normal pulses and angiograms interpreted as normal had their popliteal artery injury discovered during release of the tourniquet following the repair of their ligamentous injuries. The third patient developed a pseudoaneurysm that bled following arthroscopic repair of the knee injury.Comment: This is a selective series. There were no limb losses reported with popliteal artery injury in this group of patients, suggesting significant referral bias. However, it is important to note that both physical examination and arteriography may not detect a popliteal artery injury occurring in the setting of a knee dislocation. Despite normal arteriography and a normal physical examination, delayed presentation of a popliteal artery injury does happen. The take-home message here is that a single arteriogram or a single physical examination is not sufficient to rule out popliteal artery injury in a patient with a knee dislocation. Patients with knee dislocation should, at the very least, be followed by serial physical examinations.
CE-TTE resulted in significantly improved right and left ventricular endocardial definition and improved EDBSI. CE-TTE should be viewed as an additional imaging technique that is available to help assess patients with ACHD, especially those with nondiagnostic images.
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