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  #1  
Old 05-23-2012
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Question what test to order..pt complains of angina...

A 62-year-old man with coronary artery disease is evaluated for angina. He was diagnosed with coronary artery disease 4 years ago. Medical therapy was started with aspirin, metoprolol, isosorbide mononitrate, pravastatin, and sublingual nitroglycerin. He was asymptomatic until 8 months ago, when he noted exertional angina; his dosages of metoprolol and isosorbide mononitrate were increased and long-acting diltiazem was added, resulting in control of his symptoms. Over the past 2 months, however, he has had gradually increasing symptoms, and currently he requires daily nitroglycerin for angina relief during exercise. He has not had any episodes of angina at rest. On physical examination, blood pressure is 100/60 mm Hg and heart rate is 48/min. Carotid upstroke is normal with no bruits. Cardiac examination reveals no murmurs, and the lungs are clear. An electrocardiogram shows no acute ischemic changes.
Which of the following should be the next step in this patient's management?

(A) Coronary angiography
(B) Exercise treadmill stress testing
(C) Increase metoprolol
(D) Intravenous heparin and nitroglycerin
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  #2  
Old 05-23-2012
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wow i read something like this just yesterday
go ahead with coronary angiography.
Do not increase metoprolol. Max increase in dose should be done only till the HR>60. Since HR is 48 metoprolol is a big no-no.
No need for a EST coz he already has CAD and angina. What more can you find with an EST?
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Old 05-23-2012
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A to look for a lesion that could account for his sx may be
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Old 05-23-2012
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i think the answer shud be B.

whats the correct answer?
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  #5  
Old 05-23-2012
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its a
because she has high probability for ihd
therefore do notoorder stress test direct angio is ans

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