Question of the Week # 101

Q101.) A  65 y/o man with 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 one block and goes away with rest. He denies any chest pain now. He also reports no change in quality or intensity of his chest pain He also reports having been diagnosed with peripheral arterial disease about 2 months ago for which he was advised exercise therapy. He does experience leg pain on walking about one block which also improves with rest. His past medical history is significant for moderate COPD, Hypertension and a hernia repair about 3 years ago. His medications include lisinopril, hydrochlorthiazide and tiotropium inhaler. Physical examination is benign. The next best step in establishing the diagnosis in this patient is :
A) 2 D -Echocadiogram
B) Exercise Stress  Test ( Treadmill Stress Test)
C) Dobutamine Stress Echocardiogram
D) Persantin Stress Test
E) Cardiac Catheterization

4 Responses

  1. D…first you need to establish the Dx of stable angina prior to cath. if the case has described an acute pain right now with ST elevation (MI) then you have a window of 90 min to cath this patient and if not possible to get a cardiologist to cath him then ur alternative would be t-pA within 11 hrs (< 12 hrs) (remember to concurrently give heparin infusion).
    Do not confuse t-PA for an ischemic stroke which has to be given within 3 hrs.

  2. just want to add that t-PA is best in the first 30 min of the onset (that is not the same as the first 30 min in the ER since some patients will come to the ED few hours after the onset of their chest pain).

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