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Outpatient Chest Pain (Pretest Probability)
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Pretest probability of CAD selects the testing strategy.
Decision
Outcome
Decision
Stable chest pain. First step?
✓
Estimate pretest probability of CAD
✗
Coronary angiography for everyone
Decision
Pretest probability?
✓
Low → no additional testing
✓
Intermediate → exercise/imaging stress test
✓
High → start CAD pharmacologic therapy + expert evaluation
Outcome
No further testing
Reassure; lifestyle counseling.
Decision
Patient able to exercise with interpretable baseline ECG?
✓
Yes → exercise ECG
✓
No → pharmacologic stress imaging (dobutamine echo or vasodilator nuclear)
Outcome
Stress test; if positive → coronary angiography
Outcome
Initiate aspirin + statin + β-blocker (or CCB) + nitrate, expert evaluation
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