Version May 2024
| Cardiac evaluation | ||
| Test | Interpretation | Follow-up |
| ECG shows arrhythmia, conduction disturbance, or myocardial injury | ECG abnormalities may be a clue to underlying coronary artery or myocardial disease. Obtain treadmill/other stress test and echocardiogram. | |
| Treadmill or nuclear stress test can be helpful even in absence of chest pain | Some patients are more aware of dyspnea than chest pressure. Patients with COPD may report dyspnea that is due to comorbid cardiac disease. | Testing suggests CAD; evaluate and treat. |
| Transthoracic echocardiogram: Useful in the identification of systolic and diastolic ventricular dysfunction, hypertrophic cardiomyopathy, valvular disease, pericardial disease, and pulmonary hypertension | Echocardiogram shows reduced left ventricular systolic function (HFrEF): Likely cardiomyopathy or CAD. | Evaluate for risk factors. Initiate treatment. |
| Echocardiogram shows preserved ejection fraction (HFpEF). Assess severity and potential risk factors; initiate treatment. | Depending on response to treatment, may need right and/or left heart catheterization to confirm. | |
| Echocardiogram shows elevated PA pressure with normal systolic LV function. DDx includes pulmonary hypertension, CTEPH, HFpEF, others. Check BNP, assess for risk factors. | Consider right heart catheterization to confirm diagnosis of PH (mean PAP ≥25 and PAWP <15). Consider V/Q scan re: CTEPH. Obtain appropriate tests for secondary PH (eg, rheumatic diseases, HBV, HCV, HIV, PSG). | |
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