title: Cardiac risk factors: noninvasive testing to detect coronary heart disease.
abstract: Patients with acute chest pain should be assessed first for the likelihood of acute coronary syndrome using the Thrombolysis in Myocardial Infarction score or the Agency for Health Care Policy and Research criteria. If assessment indicates high risk, the patient should be admitted to the hospital. Low- and intermediate-risk patients whose chest pain has ceased and who have normal or unchanged electrocardiograms and troponin levels can be monitored for 6 to 8 hours. If the patient then develops recurrent chest pain, electrocardiographic changes, or increasing biomarker levels, hospital admission is warranted. If not, further testing is indicated to determine if coronary heart disease is present. Testing can include exercise treadmill tests, nuclear imaging, or stress echocardiography. Coronary computed tomographic angiography and magnetic resonance angiography currently are not standard tools for this testing. Testing also is sometimes obtained for asymptomatic outpatients with intermediate risk of coronary heart disease, with the goal of reclassifying them in low- or high-risk categories. Carotid intima-media thickness, ankle-brachial index, coronary artery calcium scores, stress tests, coronary computed tomographic angiography, and magnetic resonance angiography have been suggested for this purpose, but they only result in reclassification of small percentages of patients and are not recommended routinely.
authors.affiliation: Memorial Hospital of Rhode Island, 111 Brewster St, Pawtucket, RI 02903, david_anthony@brown.edu.
authors.forename: David
authors.initials: D
authors.lastname: Anthony
authors.affiliation: Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, Paul_George@Brown.EDU.
authors.forename: Paul
authors.initials: P
authors.lastname: George
authors.affiliation: Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, Charles_Eaton@Brown.EDU.
authors.forename: Charles B
authors.initials: CB
authors.lastname: Eaton
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000175:diagnosis; D055109:Ankle Brachial Index; D002114:Calcinosis / Q000150:complications / Q000175:diagnosis; D059168:Carotid Intima-Media Thickness; D002637:Chest Pain / Q000150:complications; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis; D003952:Diagnostic Imaging / Q000379:methods*; D025401:Echocardiography, Stress / Q000379:methods; D005080:Exercise Test / Q000379:methods*; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000379:methods