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  #1  
Old 05-18-2012
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Heart Next step after +ve stress test?

60 yr old comes with recurrent attacks of chest pain on exertion for last two months, pain relieved by
rest, EKG is normal, exercise stress test shows ST depression 3 mm in lead V3-V5 during sh minute of
Bruce Protocol, heart rate 90/min (50% of max. predicted). The test was terminated due to above
finding, what is the next recommendation?
I: Nuclear stress test
2: Cardiac Cath
3: Prescribe Nitroglycerine
4: Echocardiogram
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  #2  
Old 05-18-2012
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2: Cardiac Cath
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Old 05-18-2012
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3 mm in 2 lead it's diagnostic, proceed to 2: cardiac cath
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Old 05-18-2012
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i know that in real life they proceed with Cardiac Cath
but why here (for exam purpose), we have just dx a pt with CAD, lets try medical Rx first (nitro) i think.

also ST drop seen after how much time ??? this is critical, cuz if its too early then this is dangerous, if its late its ok
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Old 05-18-2012
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well i always use the 'rule out' strategy.
The pt has already been diagnosed with stable angina (st depression and chest pain relieved by rest) so options 1 and 4 are out.
Nitrogylcerin is more useful for an acute attack of Angina. Since the pt has recurrent attacks of angina it would be wise to cath him and proceed accordingly for a definitive Mx.
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Old 05-19-2012
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Quote:
Originally Posted by iceman_purav View Post
well i always use the 'rule out' strategy.
The pt has already been diagnosed with stable angina (st depression and chest pain relieved by rest) so options 1 and 4 are out.
Nitrogylcerin is more useful for an acute attack of Angina. Since the pt has recurrent attacks of angina it would be wise to cath him and proceed accordingly for a definitive Mx.
-but nitrat dosn't lower mortalty&cath dos
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Old 05-19-2012
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Cardiac catheterization, can be used for:
--Diagnosis, when noninvasive test are contraindicated or inadequate (e.g. due to morbid obesity or COPD).

--Prognosis "Risk Stratification" used after conventional stress tests are positive to identify who will be benefit from Stent placement or bypass surgery

kaplan IM 2009
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I also think catheter is the answer
Thank. U all for such gud replies
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