ABC | Volume 114, Nº2, February 2020

Update Update of the Brazilian Guideline on Nuclear Cardiology – 2020 Arq Bras Cardiol. 2020; 114(2):325-429 Figure 21 – Case 1 - Electrocardiogram tracing during peak stress and initial recovery with alterations (explained in the text). anamnesis and physical examination during the initial phase (I) , formulating the main diagnostic hypotheses, which are fundamental aspects for defining the best investigation strategy. Subsequently, depending on the questions formulated, relatively simple or more basic diagnostic tests are obtained (II) , such as: resting ECG, ET, resting ECHO and, eventually, CS. Subsequently, in accordance with the need for additional information and depending on the diagnostic hypotheses considered, the doctor may consider the application of more advanced non-invasive imaging techniques (III) , such as angio-CT, MPS, and, potentially, cardiac magnetic resonance. Applying scientific knowledge regarding diagnostic and prognostic value, to both basic tests and more advanced non-invasive imaging methods, it is possible to establish filters for selecting patients who will really require invasive testing, such as cardiac catheterization (IV) , notably with the aim of planning for myocardial revascularization. 9.3. Practical Examples of Integration of Modalities 1. Patient with abnormal ET, Duke score characterizing intermediate risk, and normal MPS Clinical history: female, age 50, with hypertension, dyslipidemia, atypical symptoms, and borderline ET. Referred for MPS (Figures 21 and 22). 364