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The Beta Blocker and Clonidine Protocol

Lesson 2
Lesson 2 - Epidemiology

4. Approaches to Prevention of PCM

A very wise man once told me that there are two kinds of people, those who divide things into two groups and those who don't. I think there are also people who calculate risk with little tables and parameters, and then there are the rest of us who just get a gestalt of the patient, and then say, "Woah! High risk." For those of you who don't want to guess, there are a number of expensive non-routine tests that can tell you who has coronary artery disease. These include exercise stress testing, radionuclide venticulography, Holter, stress echocardiography, coronary angiograms, and thallium scintigraphy. These tests are usually designed and validated to identify who has significant coronary artery disease. They don't usually indicate who is going to have an MI with their operation. They don't tell you if the plaque in the coronary recently fractured, or is highly thrombogenic. They tell you who is going to have a positive coronary angiogram, which is not what you really need to know.

Bertrand Russell and Albert Einstein: Two wise guys.

Approaches to Prevention of PCM

bullet Clinical Predictors (age, H&P)
bullet Risk Indices (Multivariable Analyses)
Non Routine Testing
  • Exercise stress testing
  • Radionuclide ventriculography
  • Holter
  • Stress echocardiography
  • Coronary angiography
  • Thallium scintigraphy

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Content by Art Wallace MD PhD
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