ReviewsBedside diagnosis of coronary artery disease: A systematic review
Section snippets
Methods
Using MEDLINE (January 1966 to January 2003), one author (AAC) performed the following search strategy, limited to English-language publications and human subjects, to retrieve all relevant publications on the bedside diagnosis of coronary artery disease in adults. The following Medical Subject Heading terms were combined with the terms coronary disease/diagnosis and myocardial infarction/diagnosis: chest pain/diagnosis, electrocardiography, risk factors, physical examination, and medical
Coronary artery disease
The overwhelming majority of patients in these studies presented to outpatient clinics with stable, intermittent chest pain and were subsequently referred for coronary angiography. Most studies (14, 17, 19, 22, 33, 37, 38) excluded patients with known valvular heart disease or nonischemic cardiomyopathy. Some studies used >50% stenosis of any epicardial vessel as the diagnostic standard (13, 14, 15, 16, 17, 19, 22, 23, 24, 25, 26, 27, 28, 29, 37, 38, 39, 40, 41, 42, 43, 44, 45), whereas others
Discussion
In 1768, Heberden described typical angina as a “most disagreeable sensation in the breast” that seizes patients “while they are walking” yet vanishes “the moment they stand still” (1). Modern definitions of typical angina (Table 1) retain Heberden's triad of essential ingredients—substernal discomfort, aggravation by exertion, and relief with rest—adding only that typical angina requires relief within 10 minutes of rest or within 10 minutes of taking nitroglycerin. Our review shows that this
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