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  #1  
Old 12-08-2011
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Heart Uncontrolled Chronic Angina!

A 60-year-old male patient on aspirin, nitrates, and a beta blocker, being followed for chronic stable angina, presents to the ER with a history of two to three episodes of more severe and long-lasting anginal chest pain each day over the past 3 days. His ECG and cardiac enzymes are normal.

The best course of action of the following is to

a. Admit the patient and begin intravenous digoxin
b. Admit the patient and begin intravenous heparin
c. Admit the patient and give prophylactic thrombolytic therapy
d. Admit the patient for observation with no change in medication
e. Discharge the patient from the ER with increases in nitrates and beta blockers
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  #2  
Old 12-08-2011
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I am not sure but is it D???
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Old 12-08-2011
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d. Admit the patient for observation with no change in medication
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Old 12-08-2011
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Hmm this guy's angina is becomming unstable i would admit him and start intravenous heparin..so i would go with
B. Admit the patient and begin intravenous heparin.
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Old 12-08-2011
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worsening angina so unstable..i ll also go with heparin
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Old 12-08-2011
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it's becoming more severe and long lasting so it's unstable angina
i would go for B
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Old 12-08-2011
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The answer is B.This patient presents with unstable angina, a change from the previous chronic stable state in that chest pain has become more frequent and more severe. Intravenous heparin is indicated. Subcutaneous administration of low-molecular-weight heparin (such as enoxaparin) is an alternative. There is no role for digoxin, as this may increase myocardial oxygen consumption and exacerbate the situation. Thrombolytic therapy is reserved for the treatment, typically within 6 h, of ECG-documented myocardial infarction and does not reduce cardiac events in the setting of unstable angina. A more aggressive approach is early interventional
cardiac catheterization with angioplasty and/or stent placement,possibly
in conjunction with glycoprotein IIb/IIIa inhibitors.
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The above post was thanked by:
drnrpatel (12-08-2011), fadi551 (12-09-2011)



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Cardiology-, Internal-Medicine-, Step-2-Questions

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