title: [Diagnosis of ischemia].
abstract: Clinically, coronary artery disease (CAD) presents either as stable angina pectoris or as an acute coronary syndrome. Atypical chest pain or silent myocardial ischemia is not uncommon and may obscure the diagnosis of CAD. Whereas primary or secondary prevention is indicated in all cases with suspected or documented atherosclerosis, cardiac catheterization and revascularization therapy is restricted to patients with significant CAD. In order to detect hemodynamically significant coronary artery stenoses, exercise stress tests or noninvasive stress imaging are usually implemented in the diagnostic workup. By contrast, patients presenting with an acute coronary syndrome require an initial risk stratification for estimation of the acute thrombotic risk associated with the underlying vulnerable plaque. Consecutively, patients without high-risk features need a thorough noninvasive evaluation for the presence of significant CAD which is comparable to patients presenting with chronic stable angina pectoris.
authors.affiliation: Abteilung Innere Medizin III, Medizinische Klinik, Universitätsklinikum, Heidelberg.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Kurz
authors.forename: Hugo A
authors.initials: HA
authors.lastname: Katus
authors.forename: Evangelos
authors.initials: E
authors.lastname: Giannitsis
mesh_terms: D000789:Angina, Unstable / Q000175:diagnosis* / Q000209:etiology; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis*; D003937:Diagnosis, Differential; D006801:Humans; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000209:etiology; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors