A 58-year-old man with a history of coronary artery disease is evaluated for angina. His symptoms have been well controlled with metoprolol and isosorbide mononitrate. He had exertion angina few months ago. His metoprolol and isosorbide doses were increased, with improved control of his symptoms. He had increasing symptoms over the last 2 months and now requires daily SL nitroglycerin. He didn't have angina episodes at rest. On examination BP 110/60, HR 50, RR 12, CVS exam unremarkable, ECG no changes. Which of the following should be the next step?
سؤال مجاني 1 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
الإجابة: A. Coronary angiography
His stable angina is worsening despite maximal tolerated medical therapy: HR 50 and BP 110/60 leave no room to increase metoprolol or the nitrate. Persistent, activity-limiting angina despite optimal medical treatment is an indication for coronary angiography with a view to revascularisation (PCI/CABG). An exercise test adds little since the diagnosis of CAD is already established.
ليش كل خيار صح أو غلط
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A
ليش صح
Stable angina still refractory to medical therapy is an indication for revascularisation, so the next step is coronary angiography.
✓ Step-Up To Medicine 6th (IHD & ACS).pdf · p. 7 -
B
ليش غلط
Exercise ECG is the diagnostic test for suspected stable angina; his CAD is already established and symptoms persist despite therapy.
✓ CARDIOLOGY- ISCHEMIC HEART DISEASES (IHDs).pdf · p. 4 -
C
ليش غلط
Beta-blockers are contraindicated with bradycardia (HR < 50 bpm); his HR is already 50, so metoprolol cannot safely be increased.
✓ CARDIOLOGY- ISCHEMIC HEART DISEASES (IHDs).pdf · p. 5 -
D
ليش غلط
More nitrate adds orthostatic hypotension and tolerance risk, and its main benefit is only symptomatic relief, not a definitive step.
✓ Step-Up To Medicine 6th (IHD & ACS).pdf · p. 7
- المصدر
- CARDIOLOGY- ISCHEMIC HEART DISEASES (IHDs).pdf · p. 4
Ischemic heart disease.pdf · p. 17 - المحاضرة
- Ischemic Heart Disease · Cardiology · Module B
- ظهر في
- Cardio bank