Investigations for coronary heart disease

Question 1

What are the different investigations used in the diagnosis of coronary heart disease?

Answer 1

• exercise testing
• perfusion scanning
• CT angiography
• invasive coronary angiography

Question 2

What are the pros 3 and cons 2 of exercise testing?

Answer 2

Pros
Cheap
Reproducible
Risk stratification; a positive test at low workload implies poor prognosis

Cons
Poor diagnostic accuracy in important sub-groups
Submaximal tests

Question 3

What are the pros 4 and the cons 2 of perfusion imaging?

Answer 3

Pros
Non invasive
Pharmacological stress in less mobile patients
More precision than ETT
Risk stratification

Cons
Radiation
False positives and negatives

Question 4

What are the pros 2 and the cons 3 of CT angiography

Answer 4

Pros
Non-invasive
Anatomical data and risk stratification

Cons
Radiation
Less precise than invasive angiography, particularly when calcium present
Cost

Question 5

What are the pros (3) and cons (3) of invasive coronary angiography?

Answer 5

Pros
“Gold standard”
Anatomical and risk stratification
Follow-on angioplasty

Cons
Risk 1:1000 death, stroke
Radiation
Contrast: renal dysfunction, rash, nausea