Diagnosis
Figure 2. Diagnosis of Patients with Suspected Ischemic
Heart Disease
4
Suspected Ischemic Heart Disease
(or change in clinical status in a patient wih known IHD)
NO
Recent exercise or cardiac imaging study
YES
Note: Colors correspond to the class of recommendations in the ACCF/AHA
a
CCTA is reasonable only for patients with intermediate probability of IHD
b
Go to Figure 4
c
Go to Figure 5
d
Go to Figure 6
YES
Previous coronary revascularization?
YES
NO
NO
NO
NO
Intermediate or high-risk UA?
Pharm
stress MPI
or Echo
YES
NO
YES
Pharm
stress Echo
Patient able to exercise?
Intermediate to
high likelihood
IHD
Low likelihood
IHD
OR
NO
Technically adequate?
YES
Contradictions to stress testing ?
YES
Resting ECG interpretable?
MPI or
Echo w/
exercise
Pharm
CMR or
CCTA
Comprehensive clinical assessment of risk, including personal
characteristics, coexisting cardiac and medical conditions, and health status
