Chest pain other diagnostic studies

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Aisha Adigun, B.Sc., M.D.[3]


Invasive Coronary Angiography (ICA) is used to determine the presence and severity of a luminal obstruction of an epicardial coronary artery, including its location, length, and diameter, as well as coronary blood flow. ICA provides the characterization of high-grade obstructive stenosis and possibility for percutaneous or surgical revascularization. (IFR and FFR) provide physiologic characteristic of stenosis. Radiation exposure to the patient during an interventional procedure varied 4 to 10 mSv and is dependent on procedural duration and complexity. The spatial resolution of ICA is 0.3 mm, so, visualization of arterioles (diameter of 0.1 mm) that regulate myocardial blood flow is impossible. Coronary vascular functional studies can be performed during coronary angiography. In normal coronary angiography there may be evident abnormal coronary vascular function. Assessment of coronary microcirculation and coronary vasomotion by coronary function testing are reasonable.

Other Diagnostic Studies

Contraindications of stress test for diagnosis of acute chest pain

Exercise ECG Stress Nuclear Stress Echocardiography Stress CMR Coronary CT Angiography
Reduced GFR (<30 mL/min/1.73 m2) Allergy to iodinated contrast
Uncontrolled heart failure Contraindications to vasodilator administration Inability to cooperate with scan acquisition and/or holding breath
Avoiding CMR in the presence of implanted device due to producing artifact limiting scan quality interpretatrion Clinical instability (acute respiratory distress, severe hypotension, unstable arrhythmia)
Significant claustrophobia Renal impairment
Caffeine use within past 12 hours Contraindication to beta blockade in the presence of an elevated heart rate and no alternative medications available for achieving target heart rate
Heart rate variability, arrhythmia

Contraindication to nitroglycerin (if indicated)
The above table adopted from 2021 AHA/ACC/ASE Guideline[1]


  1. Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, Blankstein R, Boyd J, Bullock-Palmer RP, Conejo T, Diercks DB, Gentile F, Greenwood JP, Hess EP, Hollenberg SM, Jaber WA, Jneid H, Joglar JA, Morrow DA, O'Connor RE, Ross MA, Shaw LJ (November 2021). "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". Circulation. 144 (22): e368–e454. doi:10.1161/CIR.0000000000001029. PMID 34709879 Check |pmid= value (help).