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Stable Ischemic Heart Disease

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Diagnosis 2 Table 3. Alternative Diagnoses to Angina for Patients with Chest Pain Nonischemic Cardiovascular Pulmonary Gastrointestinal Chest Wall Psychiatric Aortic dissection Pulmonary embolism Esophageal Esophagitis Spasm Reflux Costochondritis Fibrositis Rib fracture Sternoclavicular arthritis Herpes zoster (before the rash) Anxiety disorders Hyper- ventilation Panic disorder Primary anxiety Pericarditis Pneumothorax Pneumonia Pleuritis Biliary Colic Cholecystitis- Choledocholithiasis Cholangitis Peptic ulcer Pancreatitis Affective disorders (ie, depression) Somatiform disorders ought disorders (ie, fixed delusions) Table 4. Pretest Likelihood of Coronary Artery Disease (CAD) in Symptomatic Patients According to Age and Sex a Age, y Nonanginal Chest Pain Atypical Angina Typical Angina Men Women Men Women Men Women 30-39 4 2 34 12 76 26 40-49 13 3 51 22 87 55 50-59 20 7 65 31 93 73 60-69 27 14 72 51 94 86 a Each value represents the percent with significant CAD on catheterization. Adapted from Forrester and Diamond. N Engl J Med. 1979;300:1350-8. Table 5. Comparing Pretest Likelihood of CAD in Low-Risk Symptomatic Patients With High-Risk Symptomatic Patients Age, y Nonanginal Chest Pain Atypical Angina Typical Angina Men Women Men Women Men Women 35 3-35 1-19 8-59 2-39 30-88 10-78 45 9-47 2-22 21-70 5-43 51-92 20-79 55 23-59 4-21 45-79 10-47 80-95 38-82 65 49-69 9-29 71-86 20-51 93-97 56-84 Each value represents the percentage with significant CAD. e first is the percentage for a low-risk, mid-decade patient without diabetes mellitus, smoking, or hyperlipidemia. e second is that of a patient of the same age with diabetes mellitus, smoking, and hyperlipidemia. Both high- and low-risk patients have normal resting ECGs. If ST-T-wave changes or Q waves had been present, the likelihood of CAD would be higher in each entry of the table. Reprinted from Pryor et al. Am J Med. 1991;90:553-62.

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