Flow Diagram Showing Selection of Initial Stress Test in a Pt with Chest Pain - Flowchart

Flow Diagram Showing Selection of Initial Stress Test in a Pt with Chest Pain - Flowchart

Flow Diagram Showing Selection of Initial Stress Test in a Pt with Chest Pain - Flowchart

«Flowchart»

Choice of Test for Known/Suspected CAD

Choice of Test for Known/Suspected CAD

Choice of Test for Known/Suspected CAD

Choice of Test for Known/Suspected CAD

Exercise imaging study

Exercise imaging study

Exercise imaging study

Pharmacologic imaging study

Pharmacologic imaging study

Pharmacologic imaging study

Patient able to exercise?

Patient able to exercise?

Patient able to exercise?

Yes

Yes

Yes

No

No

No

Need structural information?

Need structural information?

Need structural information?

Need structural information?

Need structural information?

Need structural information?

Yes

Yes

Yes

No

No

No

Pharmacologic nuc^*

Pharmacologic nuc^*

Pharmacologic nuc^*

^* *

Dobutamine echo

Dobutamine echo

Dobutamine echo

End

End

End

End

End

End

LBBB or PPM
Prev MI

LBBB or PPM
Prev MI

LBBB or PPM
Prev MI

Yes

Yes

Yes

No

No

No

Dobutamine echo or pharm nuc^*

Dobutamine echo or pharm nuc^*

Dobutamine echo or pharm nuc^*

^* *

End

End

End

Previous coronary revascularization

Previous coronary revascularization

Previous coronary revascularization

Yes

Yes

Yes

No

No

No

Resting ECG interpretable?

Resting ECG interpretable?

Resting ECG interpretable?

Resting ECG interpretable?

Resting ECG interpretable?

Resting ECG interpretable?

Yes

Yes

Yes

No

No

No

Exercise ECG

Exercise ECG

Exercise ECG

End

End

End

Need structural information?

Need structural information?

Need structural information?

Yes

Yes

Yes

No

No

No

Exercise echo

Exercise echo

Exercise echo

Pharmacologic nuc

Pharmacologic nuc

Pharmacologic nuc

End

End

End

LBBB or PPM

LBBB or PPM

LBBB or PPM

Yes

Yes

Yes

No

No

No

Exercise nuc

Exercise nuc

Exercise nuc

End

End

End

Prev MI?

Prev MI?

Prev MI?

Yes

Yes

Yes

No

No

No

Either exercise nuc or exercise echo

Either exercise nuc or exercise echo

Either exercise nuc or exercise echo

End

End

End

End

End

End

* Consider PET if morbidly obese or female with large/dense breasts.

* Consider PET if morbidly obese or female with large/dense breasts.

* Consider PET if morbidly obese or female with large/dense breasts.