Smith L K
Preventive Medicine Program, Arizona Heart Institute, Phoenix.
Geriatrics. 1988 Jul;43(7):33-8.
Coronary artery disease can have various clinical manifestations, from the presence of "silent" ischemia to the occurrence of an acute myocardial infarction and congestive myopathy. At each point in the clinical manifestation of coronary artery disease, the practitioner has an evolving number of techniques available to guide decisions regarding prognosis and therapy. Guidelines exist for defining which patients with "silent" ischemia need further evaluation. The clinically manifested occurrence of angina pectoris is commonly encountered in the elderly. Prognostic stratification can occur using both invasive and non-invasive techniques. Even patients with unstable angina have different outcomes depending upon clinical presentation and therapeutic management. Finally, a large pool of patients who survive an acute myocardial infarction have a varied prognosis depending upon certain risk markers as documented with widely available non-invasive testing. This article summarizes the evaluations and decisions the physician can make regarding patients who present with the various manifestations of coronary artery disease and provides a summary of recent data supporting decisions regarding prognosis and therapy.
冠状动脉疾病可有多种临床表现，从“无症状”缺血到急性心肌梗死和充血性心肌病的发生。在冠状动脉疾病临床表现的每个阶段，医生都有越来越多的技术可用于指导有关预后和治疗的决策。对于确定哪些“无症状”缺血患者需要进一步评估，已有相关指南。临床上心绞痛的发生在老年人中很常见。可使用侵入性和非侵入性技术进行预后分层。即使是不稳定型心绞痛患者，其预后也因临床表现和治疗管理而异。最后，大量急性心肌梗死存活患者的预后因某些风险标志物而异，这些标志物可通过广泛应用的非侵入性检测记录下来。本文总结了医生针对出现冠状动脉疾病各种表现的患者可进行的评估和决策，并提供了支持有关预后和治疗决策的最新数据总结。
