If noninvasive stress testing suggests possible ischemia, what is the appropriate next diagnostic step to delineate coronary anatomy?

If noninvasive stress testing suggests possible ischemia, what is the appropriate next diagnostic step to delineate coronary anatomy?

• A. Echocardiography
• B. Cardiac MRI
• C. Cardiac catheterization
• D. Pulmonary function testing

Answer: (C)

When noninvasive testing suggests ischemia, you want a definitive map of the coronary arteries to identify where blockages are and plan treatment. Cardiac catheterization with coronary angiography provides direct visualization of the coronary lumen using contrast, revealing the location, severity, and extent of stenoses and guiding decisions about revascularization (PCI or CABG). It can also include hemodynamic assessment if needed. Echocardiography mainly evaluates structure and function, and can show wall-motion abnormalities but does not delineate coronary anatomy. Cardiac MRI can assess perfusion and viability noninvasively but does not offer the same detailed view of the coronary arteries. Pulmonary function testing has no role in assessing coronary anatomy. Thus, the step to delineate coronary anatomy is cardiac catheterization with angiography.

When noninvasive testing suggests ischemia, you want a definitive map of the coronary arteries to identify where blockages are and plan treatment. Cardiac catheterization with coronary angiography provides direct visualization of the coronary lumen using contrast, revealing the location, severity, and extent of stenoses and guiding decisions about revascularization (PCI or CABG). It can also include hemodynamic assessment if needed.

Echocardiography mainly evaluates structure and function, and can show wall-motion abnormalities but does not delineate coronary anatomy. Cardiac MRI can assess perfusion and viability noninvasively but does not offer the same detailed view of the coronary arteries. Pulmonary function testing has no role in assessing coronary anatomy. Thus, the step to delineate coronary anatomy is cardiac catheterization with angiography.