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 A 55 y/o women now presents with...  

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A 55 y/o women now feels a sudden moderate chest pain
while arranging her own office, and you are near at hand.
She also seems anxious. You know that she currently
suffers urinary incontinence. What is the likely cause of
her chest pain? and what is the proper managment?


Side effect or overdose from the drug using for urinary incontinence is the cause of her chest pain; that's what I could guess from your question; stop drug immediately and seek medical blood test and possible treatment. If you can give more in detail, like how is the feature of chest pain, what kind of urinary incontinence she has and what kind of treatment she has, that would helpful to make a better guess or diagnosis. Thanks.


Hello M.A.S.

I agree with Tess, it is a cardio side effect of TCA being used to TX the incontinence. Please do let us know what the answer is. Thanks for the question.


Excuse me, I'm sorry for the delay, I have just finished the summer training - meanwhile which I had no time to connect.

You are both correct.

The chest pain was heavy in quality -not sharp. It was moderate and lasted about 10 min. There was a mild dyspnea. It was the second time she feel the same chest pain. She has no familial hx of CAD.

Of cource, you will ask about the type of her incontinence and the drug she uses; it is urge incontinence and the drug is oxybutynin (Ditropan), she takes 5 mg two times a day, 3 months ago. The drug must be stopped or the dose should be decreased.

- tess, what is the usefulness of blood tests?
- should you give her any medication to relieve the pain (e.g. sublingual NTG)?



I think she should be given SL NTG

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