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Old 06-16-2014
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Default real cardio patient question

65 yr old patient underwent angioplasty with drug eluting stent. post angioplasty the patient can climb 10 floors at a time without any kind of chest discomfort, he can even speed walk for 30 mins with no symptoms.

currently the patient suffers from back pain that radiates to his chest, patient comfirms that it is not similar to the angina he used to get before angioplasty.

pain regresses on nsaid's but not on proton pump inhibitors and returns after 4-5 hrs. echo, ecg, trop-t done on 4th. day post angioplasty do not show any pathological changes.

current treatment is prasugrel, metoprolol, lisinopril, atorvastatin, aspirin.

what do my fellow usmle givers thinks it is..

1.) non cardiac chest pain
2.) osteochondritis
3.) stretch pain due to stent
4.) psychological factor
5.) something other than the above options

plz do reply with ur suggestions & explanation if u have other than the above options, its not a usmle questions its a real questions.

thank u. wud really aprreciate ur reply.
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Old 06-16-2014
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This is a common clinical scenario after angioplasty. Based on your description, the pain is "non cardiac" meaning unrelated to coronary disease, angioplasty, or any of the medications. I am a cardiologist and deal with this all the time. You can email me at drryan@boardsbeyond.com Please also check out my website for USMLE review by Googling "Boards and Beyond Jason Ryan."
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Old 06-16-2014
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Quote:
Originally Posted by drryan View Post
This is a common clinical scenario after angioplasty. Based on your description, the pain is "non cardiac" meaning unrelated to coronary disease, angioplasty, or any of the medications. I am a cardiologist and deal with this all the time. You can email me at drryan@boardsbeyond.com Please also check out my website for USMLE review by Googling "Boards and Beyond Jason Ryan."

ya, i am still going with non cardiac pain but doctor ryan do you exactly know when the pain decreases, its been 8 days my patient is suffering from such pain and now a days nsaid's have less effect.

i am going to perform an stress ecg today. if the results come out to be normal then i am thinking of starting the patient on low dose morphine or opiods like tramadol.

any suggestions on when it stops and its treatment.
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