Q100) A 52 year-old man presents to your office with complaints of exertional chest pain for the past 4 weeks. The chest pain is usually left sided, occurs on walking about three blocks and goes away with rest. He has developed a habit of taking rest when the chest pain comes and he did not think it needed medical attention until his friend told him yesterday that it might be a symptom of heart disease. He is concerned and requests your recommendation. He denies any chest pain or shortness of breath now. He also reports no change in quality or intensity of his chest pain. His past medical history is significant for Hypertension and Smoking . His medications include lisinopril and hydrochlorthiazide. Physical examination is benign. The next best step in establishing the diagnosis in this patient is :
c
c
C
A.. EKG should be done first
a then c
the answer key says c is the correct…..but it is wrong.
when there are baseline abnormalities on ekg you cannot do stress test ekg.so the first step though it may be normal the answer should be electrocardiogram
Thank you the query , abnormalities on EKG alone are not a contraindication for exercise stress test because EKG component is almost always accompanied by nuclear component in exercise stress test.
the history itself is suggestive of angina…why put patient on exercise stress test may precipate MI…
Chest pain, Cardiac in origin— EKG always! always! always!
You won’t do your woman with clothes on, you need to follow a stepwise protocol!
I think your blood’s Corad Fischer ‘s level is really low buddy!
the next step in management of suspicious ischemic event (especially if patient is able to exercise and have legs and arms !is stress test no matter what) , read the q one more time , he is not having the chest pain NOW , otherwise yes , even nurse practitioner would order an EKG before even you tell them to do so!!!
Next step should be A. Check out AHA guidelines since depending on whether the baseline ECG is interpretable or not, one decides whether do do simple exercise test w ECG or exercise test with imaging such as ECHO.
For CAD always do EKG as the first step. Even have normal lungs, no leg pathology, on caffiene…. EKG is the best initial step.