gordon
Forum Newbie
Topics: 5
Posts: 27
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A 64-year-old man is evaluated in the emergency department for epigastric chest discomfort and episodes of dyspnea with moderate activity. The discomfort started 2 days ago and has been intermittent, occurring mostly at rest. He works in an office and is relatively inactive. He had been using antacids for several months with variable response. He has no significant medical history and takes no other medications.
Blood pressure is 150/85 mm Hg and heart rate is 81/min; there is no jugular vein distention or carotid bruits; cardiac examination reveals a normal S1 and S2, with no murmur, gallop, or clicks. Examination of the abdomen and extremities is normal. Electrocardiogram shows flattened T waves. He is treated with enoxaparin, a β-blocker, aspirin, and sublingual nitroglycerin and admitted to the chest pain unit for observation. Serial measurements of cardiac enzymes are normal, and there are no changes on the subsequent two electrocardiograms.
Echocardiogram shows a left ventricular ejection fraction of 35% to 40% with global hypokinesis and mild mitral regurgitation.
What is the next most appropriate step in the management of this patient?
A Heparin
B Eptifibatide
C Exercise perfusion imaging stress test
D Coronary angiography
E Exercise electrocardiography stress test
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| paviraj
Forum Senior
Topics: 1
Posts: 59
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coronary angiography as CAD is the most common cause of dialated cardiomyopathy leading to CHF. So do coronary angiogram for detection of obstruction.
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| dr.wad
Forum Senior
Topics: 3
Posts: 350
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D_ coronary angiography
resting ECG and echo already showed the abnormalities >>>so the exercise tests will add nothing.
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| Dr.D
Forum Senior
Topics: 22
Posts: 191
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I think E
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| starcraftbw
Forum Senior
Topics: 13
Posts: 166
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D (pt can't exercise with that low EF...Echo already showed CAD)
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