Question of the Week # 96

Q96) A 65 year old man with history of DM type II presents to your office with complaints of chest pain that he has been having lately. He denies any pain now. He says his chest pain is more left sided and about 5/10 in intensity and it appears after walking about 2 blocks. The pain disappears after resting for a while. He has been having these chest pain episodes for the past 3 months.  He also reports severe cramps and bilateral leg pain upon walking a block that is also relieved by rest. He denies any shortness of breath. He has smoked about 1 pack per day for the past 40 years. He denies any cough.  His only medications are Glyburide and Metformin. An EKG is obtained in the office and it reveals non-specific ST segment changes. Next important step in managing this patient:

A) CT angiogram of Chest

B) Exercise Treadmill Stress test

C) Obtain Cardiac Enzymes

D) Dipyridamole Stress test

E) Start Calcium Channel Blocker

13 Responses

  1. D

  2. It is a stable angina, which needs further work up
    answer = B

    a- Angiogram should be done after a stress test to check disease extension decide treatment
    c- Patient is asymptomatic now, it does not look like MI
    e- CCB, not a first like agent ( patient is asymptomatic)

    • Good explantions for everything else, except patient has PAD and needs dypridamole or adenosine thallium stress tests.

  3. D
    cause PDA

  4. d cause leg pb

  5. ddd

  6. D

  7. b

  8. B

  9. are we just going with the democratic approach to answering these questions? 🙂

  10. ans ddd
    pt can not walk so no exercise stress test.

  11. this is STABLE angina with PAD. exercise stress test is the next step in evaluation. but since PAD is present a dipyridamole or a dobutamine stress test should be done. ECG would be normal (by the definition of stable angina)
    its not unstable because there is no increase in the frequency, intensity, duration of angina. also it is not at rest in this patient. neither has there been a defined response to nitrates, decreasing response would be unstable angina.
    had it been unstable then the next step is an ECG and cardiac enzymes to rule out non STEMI / STEMI

  12. Diabetic and silent MIs?? In reality, there is no way this guys not going to get serial trops with an abnormal ECG before any stressing!

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: