AAAAA
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A 78-year-old man is brought to the emergency department because of malaise, fatigue, and mild dyspnea on moderate activity. He has also had intermittent chest pain for 5 days; the most severe episode occurred 2 days ago. He has been pain-free since that time. His medical history includes hypertension and type 2 diabetes mellitus; his medications include an angiotensin-converting enzyme inhibitor and metformin.
His blood pressure is 112/82 mm Hg and pulse rate is 92/min. Estimated jugular venous pressure is 5 mm Hg; there are no carotid artery bruits. The lungs are clear. Cardiac examination reveals a normal S1 and S2, an S4, a grade 2/6 holosystolic murmur at apex to axilla, and diminished leg pulses and no edema. Electrocardiogram shows sinus tachycardia with Q waves in leads V1 through V4. Renal function and hematocrit are normal. Serum creatine kinase is 120 U/L and serum troponin is 6.8 ng/mL (6.8 μg/L) (normal <0.5 ng/mL). Chest radiograph shows mild pulmonary vascular redistribution and a normal cardiac silhouette. Enoxaparin and aspirin are added to his current medications.
Which of the following is the next most appropriate therapeutic approach?
A Clopidogrel B Glycoprotein receptor blocker C Fibrinolysis D Urgent coronary angiography E β-Blocker
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| AAAAA
Forum Fanatic
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Posts: 1,991
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A 78-year-old man is brought to the emergency department because of malaise, fatigue, and mild dyspnea on moderate activity. He has also had intermittent chest pain for 5 days; the most severe episode occurred 2 days ago. He has been pain-free since that time. His medical history includes hypertension and type 2 diabetes mellitus; his medications include an angiotensin-converting enzyme inhibitor and metformin.
His blood pressure is 112/82 mm Hg and pulse rate is 92/min. Estimated jugular venous pressure is 5 mm Hg; there are no carotid artery bruits. The lungs are clear. Cardiac examination reveals a normal S1 and S2, an S4, a grade 2/6 holosystolic murmur at apex to axilla, and diminished leg pulses and no edema. Electrocardiogram shows sinus tachycardia with Q waves in leads V1 through V4. Renal function and hematocrit are normal. Serum creatine kinase is 120 U/L and serum troponin is 6.8 ng/mL (6.8 μg/L) (normal <0.5 ng/mL). Chest radiograph shows mild pulmonary vascular redistribution and a normal cardiac silhouette. Enoxaparin and aspirin are added to his current medications.
Which of the following is the next most appropriate therapeutic approach?
A Clopidogrel
B Glycoprotein receptor blocker C Fibrinolysis
D Urgent coronary angiography
E β-Blocker
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| amirhossein
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B is correct. No need for clopidogrel coz he is already on Aspirin. Cath is needed but not urgent. he is diabetic, so we don't use beta-Blocker. He has already past MI and developed Q waves, no need for fibrinolysis at this time.
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| AAAAA
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B is wrong
B is incorrect. No need for clopidogrel coz he is already on Aspirin. Cath is needed but not urgent. he is diabetic, so we do use beta-Blocker. He has already past MI and developed Q waves, no need for fibrinolysis at this time.
The issue is the patient will die of cardiovascular disease instead of complications from diabetic and is glucose really goes up and how much.
How many diabetics are on beta-blockers?
I am a diabetics and many, many patietns have both CAD and diabetics and on beta-blockers
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| amirhossein
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He should get cath, so he needs plavix before that. This was my reason.
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| AAAAA
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amirhossein wrote:
He should get cath, so he needs plavix before that. This was my reason.
Absolutely right, any patient scheduled for cath should be on Plavix, but the question ask what?
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| PGI2alpha
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heyy...b4 cath do we want abciximab or do we want clopidogrel....me got confused
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