By Joseph S. Alpert (auth.), Joseph S. Alpert MD (eds.)
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Extra info for Cardiology for the primary care Physician
Preoperative assessment of the patient is generally easily carried out, with history, physical examination, and ECG being all that is necessary for the majority of patients. Using some form of risk assessment criteria such as those in the ACC/ AHA guidelines is helpful and may select out patients in whom further functional or anatomic information is needed. Exercise testing, dipyridamole-thallium imaging, echocardiography, dobutamine stress echocardiography, and cardiac catheterization provide additional information in situations in which the expense and risk (in the case of catheterization) can be justified.
When a history of preexcitation is present, adenosine must be used with caution, because it may induce ventricular fibrillation. When a wide QRS complex is present, it is often difficult to differentiate between ventricular tachycardia and SVT with aberrant conduction. However, criteria have been defined to improve the accuracy of the ECG diagnosis for wide complex tachycardias (Table 2) . Chamber Enlargement/ Left Ventricular Hypertrophy Although there are established criteria for diagnosing chamber enlargement, the anatomic correlation tends to be poor.
Ni or plem flexure ditemion Mu ulo kclctal yndr! Kk outlet 'nummc ternal or rib fraclure lapping rih . 1 m, inflammJtinn, or in ar lion lerna! marTIn p'lin (acute leukemia) Tr urn .. Cardiology for the Primary Care Physician ur 10 . lln yndr me Ii cdlancou Diaphra mati pa m or Autt r upcrfici I Ihrombophle iIi ( Jonu( r' 'ndr me) IcdiJ tlnili lediJ tinal emph -m ledlJ rlllJI tum r Unstable Angina Pectoris Unstable angina is characterized by a less predictable course with a higher likelihood of going on to an acute MI or sudden death.