New system devised to guide doctors treating patients with symptomatic myocardia... (nto three categories: 58 were in ...)

New system devised to guide doctors treating patients with symptomatic myocardial bridging

Date:6/26/2008

nto three categories:

58 were in class A Having clinical symptoms but no objective signs of ischemia.
62 were in class B Having clinical symptoms and objective signs of ischemia by non-invasive stress tests.
37 were in class C Having clinical symptoms and objective altered intracoronary hemodynamics, based on angiography and intracoronary Doppler with or without signs of ischemia by non-invasive stress tests.

Based on initial observations and five-year follow-up, the cardiologists propose a new diagnostic work-up and therapeutic strategy:

Type A: No further diagnostic work or therapy is needed. Nitrates should be avoided. In rare cases, beta-blockers might be considered temporarily to relieve symptoms.

Type B: Initiate beta-blockers or calcium channel blockers. If symptoms are not relieved, quantitative coronary angioplasty or invasive blood-flow studies should be performed, after which stenting may be considered if there is objective evidence of reduced blood flow to the heart muscle.

Type C: Initiate beta-blockers or calcium channel blockers. If symptoms are refractory, consider stenting of the bridged segment.

"One of the our most important recommendations is that Type C patients those with hemodynamic changes always be treated, regardless of results of non-invasive stress testing," Schwarz said, adding that the authors believe the new classification system will enable cardiologists worldwide to better risk-stratify and treat patients with this frequent congenital coronary anomaly.

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Contact: Sandy Van
sandy@prpacific.com
800-880-2397
Cedars-Sinai Medical Center
Source:Eurekalert

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