DadooKhan
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A 48-year-old man was brought to the emergency department because of severe
chest pain that apparently had been ongoing for over 3 hours. The man had been
suffering from chronic stable exertional angina for one year, and from duodenal ulcer for
3 years. His current medication included isosorbide mononitrate and verapamil for
angina, and famotidine for duodenal ulcer. One week ago the patient stopped the
antianginal medications, since he had not had anginal attacks during the last month.
Which of the following events most likely triggered the syndrome of this patient?
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| usmlekiller
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choices?
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| alirizvi
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E. Non-dihydropyridine slow AV conduction and allow longer diastole so u can supply more Q through the coronary circulation. This patient stops taking verapamil while still on Nitrate.. So dec VR dec preload dec SV dec CO and dec blood pressure at the baroreceptor and reflex tachycardia, back to dec diastole period and dec Q through the coronary.
killer, the options are on top of the page  lol
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| SILVER
DoWhatYouGotToDo!
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C
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| DadooKhan
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submit your vote to the polls plz.
Answer will be posted tomorrow
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| alirizvi
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haha i have a feeling i am wrong =(
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| brainstem
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C
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| usmlekiller
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haha ali he posted the choices after i wrote 'choices?" lol and its C for sure
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| DadooKhan
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Correct answer: C
Explanation: (Katzung, pp 188, Opie, pp 42)
Long term nitrate therapy should be discontinued gradually since there is clinical evidence that
severe myocardial ischemia may occur in persons withdrawing suddenly from long-term organic
nitrate exposure.
A) Unlike unstable angina, stable exertional angina very rarely progresses to myocardial
infarction. Moreover the fact that the patient had no attacks during the last month indicates that
the therapy was appropriate.
B, D) Unlike cimetidine, famotidine has no inhibitory effects on drug metabolism
E) A too high dose of nitrates may cause reflex tachycardia by reducing the blood pressure, but
this is quite unlikely in this patient since he was receiving verapamil which actually decreases
the heart rate.
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| alirizvi
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Did this patient stop all the medication at once or were we supposed to assume which one he stoped out of the 2 ? i assumed he stoped taking verapamil while still on nitrate =/
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| SILVER
DoWhatYouGotToDo!
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ali, ques. has it in the stem that he stopped all anti-anginal meds:-
One week ago the patient stopped the antianginal medications, since he had not had anginal attacks during the last month.
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| alirizvi
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"isosorbide mononitrate and verapamil for angina " i think this is why i assumed that he was taking verapamil for angina and nitrate for fun lol.. thnx for clarifying silver, i think i just over speculated this question.
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| usmlekiller
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nitrate for fun lolll
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| SILVER
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| meawanderer
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The correct answer should be C, if he stopped all medications.
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