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Old 08-16-2012
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Question increasing chest discomfort !! most apt dx test q...

A 65-year-old man is evaluated for 2 months of central chest pain with exertion and relief
with rest, exertional dyspnea, orthopnea, and lower-extremity edema. The chest discomfort is
increasing in frequency and severity. He has a 25-year history of hypertension and a 44-year
history of smoking. His only medication is hydrochlorothiazide.
On physical examination, blood pressure is 118/80 mm Hg, pulse is 95/min, and respiration
rate is 16/min. There is jugular venous distention. Cardiac examination reveals a regular
rhythm. S1 and S2 are normal, and an S3 and S4 are present. Crackles are heard at both lung
bases. There is edema at the ankles. Laboratory studies show a normal serum troponin T
level. Electrocardiogram is normal. Echocardiogram shows an ejection fraction of 40%, global
hypokinesis, and left ventricular hypertrophy.
Which of the following is the most appropriate diagnostic test?
(A) Cardiac angiography
(B) Nuclear medicine stress test
(C) Radionuclide ventriculography
(D) Standard exercise stress test
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Old 08-16-2012
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(A) Cardiac angiography - Patient with hypertension seems to be having MI, depressed ventricular function as well so locate the stenosis and possibly follow with PCI or CABG?
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Old 08-16-2012
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Radio ventriculography or MUGA
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Cardiology-, Internal-Medicine-, Step-2-Questions

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