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  #1  
Old 05-10-2012
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Heart Recurrent Stable Angina; Best Next Step?

A 65-yr-old is coming to the physician for recurrent stable angina. He's currently receiving Verapamil, Metoprolol, Sublingual Nitroglycerine, Low-dose Aspirin, and Atorvastatin. He states that he has been taking all his medications as instructed. His hear rate is 60/min, blood pressure 125/80. The physician explains the benefit of long term management. Which of the following is the best next step in patient care.

a) thalium 201 cardiac scintigraphy
b) coronary angiography
c) start oral warfarin
d) start thrombolytics
e) start fosinopril
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  #2  
Old 05-10-2012
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B so he can undergo PCI or CABG?
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Old 05-10-2012
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Quote:
Originally Posted by neoeinstein View Post
B so he can undergo PCI or CABG?
why not A?
dont we normally do a stress test before angio?
and if hte patient cant do a stress test we'd do a thalium with either dobutamine or something.
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Old 05-10-2012
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Quote:
Originally Posted by mbbs2010 View Post
why not A?
dont we normally do a stress test before angio?
and if hte patient cant do a stress test we'd do a thalium with either dobutamine or something.
I was thinking he has no indication for isotope stress test. If the choice is simple exercise tolerance testing, it would be better. Im not sure.

and let's say exercise tolerance testing is in the choices, im wondering what its purpose since you already diagnosed the pt as Chronic stable angina. Stress test is only done if you are considering the pt has stable angina and the EKG is normal. Not sure.
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Quote:
Originally Posted by neoeinstein View Post
I was thinking he has no indication for isotope stress test. If the choice is simple exercise tolerance testing, it would be better. Im not sure.

and let's say exercise tolerance testing is in the choices, im wondering what its purpose since you already diagnosed the pt as Chronic stable angina. Stress test is only done if you are considering the pt has stable angina and the EKG is normal. Not sure.
yup that makes sense.. infact its the exact same logic they gave (but explained really weirdly! )

the answer is A

thanks for the help.. n good going!
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Old 05-10-2012
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No problem man, I thought I was wrong anyway. Ill post some questions too later.
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Old 05-11-2012
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Unhappy how is it A

i did't get it how the ans is A
the pt is on medication for stable angia --> he's already diagnosed
pt is not responding to optimal medical Rx --> angio to look at coronary anatomy and see if the pt fit for pci/cabg (better at relieving sx than medical; but not better at preventing future cardiac events)

but shall we still need a stress test in this case to determine the severity of angia before proceeding to angio (is that's the case here)
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But I think totally different.... I think, calcium channel blocker should be replaced by Ace inhib. so should be > e) start fosinopril
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Old 05-11-2012
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I don't still get it why A is your answer

This patient has an indication for elective revascularisation (persistent symptoms despite max medical therapy)

To me it should be B ( Angiography..)




Quote:
Originally Posted by mbbs2010 View Post
yup that makes sense.. infact its the exact same logic they gave (but explained really weirdly! )

the answer is A

thanks for the help.. n good going!
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