STRESS FARMACOLÓGICO X ESFORÇO

Por que a obcessão dos ecocardiografistas brasileiros pelo ECOSTRESS farmacológico? Particularmente em um grande serviço da capital paulista...
Bom, como obcessão é assunto para terapia e não para blogs, vamos aos fatos

ACC/AHA 2002 Guideline Update for the Management of

Patients With Chronic Stable Angina

4. Stress Imaging Studies: Echocardiographic and
Nuclear
Recommendations for Cardiac Stress Imaging as the
Initial Test for Diagnosis in Patients With Chronic
Stable Angina Who Are Able to Exercise
Class I
1. Exercise myocardial perfusion imaging or exercise
echocardiography in patients with an intermediate
pretest probability of CAD who have one of the following
baseline ECG abnormalities:
a. Pre-excitation (Wolff-Parkinson-White) syndrome.
(Level of Evidence: B)
b. More than 1 mm of ST depression at rest. (Level of
Evidence: B)
2. Exercise myocardial perfusion imaging or exercise
echocardiography in patients with prior revascularization
(either PCI or CABG). (Level of Evidence: B)
3. Adenosine or dipyridamole myocardial perfusion
imaging in patients with an intermediate pretest probability
of CAD and one of the following baseline ECG
abnormalities:
a. Electronically paced ventricular rhythm. (Level of
Evidence: C)
b. Left bundle-branch block. (Level of Evidence: B)


Como se vê, o ecocardiograma de esforço é o exame preferencial para 90% dos pacientes.
Mas é só mais um guideline americano... ( www.acc.org)



--
José Roberto