1.
Cardiac risk factors: noninvasive testing to detect coronary heart disease.
Anthony, D, George, P, Eaton, CB
FP essentials. 2014;:21-7
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.
2.
Cardiovascular considerations in middle-aged athletes at risk for coronary artery disease.
Reamy, BV, Ledford, CC
Current sports medicine reports. 2013;(2):70-6
Abstract
Cardiovascular disease remains the leading cause of death in the United States despite a 50% decrease in deaths from myocardial infarction and stroke in the past 30 years associated with improvements in blood pressure and lipid control. The National Health and Nutrition Evaluation Survey found that the least prevalent metrics of cardiovascular health in adults were healthy diets, normal weights, and optimal levels of exercise. A further reduction in rates of cardiovascular disease will require an increase in exercise. Clinicians who encourage exercise in middle-aged patients face several dilemmas. This article reviews exercise-related risks for sudden death and the performance of a global cardiovascular risk assessment. The need for additional preexercise risk stratification with electrocardiogram, graded exercise testing, or echocardiography is outlined. In addition, the optimum choice of medications for hypertension or dyslipidemia treatment and the effects of these medications and aspirin on endurance exercise are reviewed.