A 70-year-old man is evaluated because of a 3-month history of worsening angina pectoris with mild exertion despite routine use of prophylactic nitroglycerin. He has had chronic, stable angina pectoris with moderate exertion for many years. Current medications are a metoprolol, isosorbide mononitrate, aspirin, atorvastatin, and lisinopril. On examination, his resting pulse rate is 50/min, and resting blood pressure is 170/95 mm Hg. Which of the following is the most likely diagnosis?
سؤال مجاني 4 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
الإجابة: D. Unstable angina
Chronic stable angina that over 3 months now comes on with mild exertion despite full anti-anginal therapy is a crescendo pattern = unstable angina. Stable angina occurs at a consistent level of exertion and is relieved by rest/nitrates. There is no troponin or ECG evidence to call it NSTEMI, and Prinzmetal angina is vasospastic rest pain (often at night), not exertional worsening.
ليش كل خيار صح أو غلط
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A
ليش غلط
NSTEMI is differentiated from unstable angina by positive troponins; none is reported here, and the picture is a crescendo angina pattern.
✓ Step-Up To Medicine 6th (IHD & ACS).pdf · p. 11 -
B
ليش غلط
Prinzmetal angina is spontaneous angina that occurs at rest (especially at night or early morning), not exertional pain that is worsening.
✓ CARDIOLOGY- ISCHEMIC HEART DISEASES (IHDs).pdf · p. 7 -
C
ليش غلط
Stable angina occurs at a consistent level of exertion; his now comes on with mild exertion despite therapy, so it has progressed.
✓ Step-Up To Medicine 6th (IHD & ACS).pdf · p. 11 -
D
ليش صح
Stable angina can progress to unstable angina, which includes angina with a crescendo pattern, as here.
✓ Step-Up To Medicine 6th (IHD & ACS).pdf · p. 11
- المصدر
- Step-Up To Medicine 6th (IHD & ACS).pdf · p. 11
- المحاضرة
- Acute Coronary Syndrome · Cardiology · Module B
- ظهر في
- Cardio bank