Testing algorithm for patients with mild stenoses

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Testing algorithm for patients with mild stenoses Testing algorithm for patients with mild stenoses. For patients presenting with angina but no flow limiting coronary lesions, we recommend coronary reactivity testing, first with acetylcholine and then with adenosine. Normal coronary arteries vasodilate in response to acetylcholine. Therefore, observations of vasoconstriction in combination with symptoms or electrocardiogram (ECG) changes are highly suggestive of endothelial dysfunction and vasospastic disease. Additionally, patients with coronary flow velocity reserve <2.5 are considered to have microvascular disease. If this occurs without notable findings in response to acetylcholine, then the patient has endothelium-independent microvascular dysfunction. On the other hand, if it occurs with vasoconstriction to acetylcholine, then the patient is considered to have both endothelial and microvascular dysfunction. Abbreviations: CFR, coronary flow reserve; FFR, fractional flow reserve. (Based on Radico F, Cicchitti V, Zimarino M, De Caterina R. Angina pectoris and myocardial ischemia in the absence of obstructive coronary artery disease: practical considerations for diagnostic tests. JACC Cardiovasc Interv. 2014 May;7(5):453-463.) Source: Emerging Clinical Applications of Physiologic and Intravascular Imaging Tools, Interventional Cardiology, 2e Citation: Samady H, Fearon WF, Yeung AC, King III SB. Interventional Cardiology, 2e; 2017 Available at: http://accesscardiology.mhmedical.com/DownloadImage.aspx?image=/data/books/1986/intercard2_ch26_f003.png&sec=165115435&BookID=1986&ChapterSecID=165115413&imagename= Accessed: October 14, 2017 Copyright © 2017 McGraw-Hill Education. All rights reserved