docdoc9
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Posts: 513
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A 46-year-old man with a history of hypertension and hypercholesterolemia visits the physician
for a routine followup. The patient's job involves a lot of traveling, and he admits to
occasionally forgetting to take his medications with him when he travels. He complains of
several episodes of chest pain in the past few months. The pain is sharp in nature, mainly over
his lower chest and epigastrium, and tends to come on when walking. He believes these
episodes are due to indigestion and has been taking antacids. There is a family history of heart
disease, and his father died of a heart attack at age 48. On physical examination, his blood
pressure is 150/80 mm Hg and heart rate is 86/min. His lungs are clear to auscultation.
Cardiac auscultation reveals normal rate and rhythm, without rubs, gallops, or murmurs. There
is no pedal edema. He is sent for an exercise stress test. Five minutes into the test, he
develops ST depression of 3 mm in leads V1-V5. The ST segment depression is greater then
0.12 seconds in duration, and the stress test is stopped. Which of the following is the most
appropriate next step in management?
A. Coronary angiography
B. Holter monitor
C. No further tests are required
D. Repeat stress test with thallium
E. Upper gastrointestinal endoscopy
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| Eagle_303
Forum Guru
Topics: 77
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Coronary angiography
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| hitesh
.
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___________________
12/28
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| docdoc9
Forum Guru
Topics: 63
Posts: 513
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The correct answer is A.
The patient has multiple risk factors like coronary artery disease: hypertension, hypercholesterolemia, as well as a positive family
history. A stress test is considered positive when there are ST depressions of greater
than 1 mm that last longer than 0.08 seconds or when there is development of
hypotension (10 mm Hg drop in systolic blood pressure) or the appearance of S3 or S4
heart sounds. Patients with positive stress tests require a coronary angiogram as the
next step to assess the need for revascularization.
Edited by docdoc9 on 09/02/08 - 05:15 AM
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