robin082006
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A 46-year-old male presents to emergency room for evaluation of his retrosternal chest pain. The pain has been occurring over the past few days. It usually occurs at rest and goes away spontaneously. It feels like a pressure sensation, is 6/10 in severity, and radiates to his lower jaw, left shoulder and upper arm. He does not have DM, HTN, or dyslipidemia. He is a non-alcoholic and non-smoker. He denies any family history of early CAD. On examination his PR: 75/min and regular; BP: 134/70 mmHg; Temperature: 36.9C(98.4F); RR: 14/min. Systemic examination is unremarkable. Chest x-ray is normal. EKG shows transient ST segment elevation in inferior leads during an episode of pain witnessed in the ED. Troponins and CK-MB are normal. Coronary angiogram showed normal coronary arteries. Which of the following is the most appropriate pharmacological therapy in this patient?
A. Diltiazem alone
B. Diltiazem and aspirin
C. Aspirin and nitrates
D. Propranolol, aspirin, and nitrates
E. Propranolol and aspirin
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| mjl1717
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my semieducated guess is:
diltiazem and aspirin, {thinking that nitrogycerine works more on veins.
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| sarika
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i think its A diltiazem....i remember reading somewhere that aspirin worsens prinz angina.
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| Guptashutosh
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A dilzem, no need 4 aspirin here, as there is no evidence of athero, lipid profile is normal, he is not htn
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| webjeee
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robin, is the answer a?
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| Aashi
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A------->only CCB
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| prathapdoctor
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Diltiazem alone,because aspirin precipitates variant angina
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| Geroo
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I go with A
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| robin082006
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answer is A
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