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* Cardio????????
 #835830  
  mounika1980 - 01/03/17 23:13
 
  A 32 year old had presented to office with complaints of recurrent chest pain .The patient describes pain as a substernal squeezing pressure which occurs during exertion, lasting for 5 minutes and is not relieved by rest.Past,Personal,Family history is unremarkable.Physical examination revealed mildly anxious patient ,no pallor,cyanosis or clubbing.Chest auscultation was normal.There were no Audible murmurs.

B.P= 120/70
P.R=90/MIN
RR=14
TEMP=98.4F

An EKG preformed was normal.
CXR= Normal


What is the next best step ?


A Reassurance

B Angiography

C Stress EKG

D Endoscopy
 
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* Re:Cardio????????
#3322846
  heartlocker - 01/03/17 23:47
 
  C Stress EKG

Symptoms s/o Unstable Angina.
Though anxiety could be a d/d which would be a probability after -ve Stress EKG.

A Reassurance if Stress EKG -ve

B For the age with no family history and normal EKG(and without stress EKG results), Angio can be awaited for Stress EKG results.

D Endoscopy --the nature of pain warrants a stress EKG then later we can perform one to rule out GERD/PUD
 
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* Re:Cardio????????
#3323688
  qikjon - 01/10/17 21:03
 
  Dd  
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* Re:Cardio????????
#3323692
  witchdoctor - 01/10/17 21:15
 
  she has a low pretest probability of heart disease , less than 10% so I only reassure and no further testing is required  
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* Re:Cardio????????
#3323695
  witchdoctor - 01/10/17 21:19
 
  sorry , the question doesn't say if a male or female patient
if female she has low pretest probability of CAD---REASSURANCE
if male he has an intermediate pretest probability of CAD--- stress EKG
 
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* Re:Cardio????????
#3323745
  helperimg2014 - 01/11/17 12:30
 
  I would look at the TIMI score and make a decision. Agree with above answers. In the real world, doing nothing, is like working on a recipe for a lawsuit.  
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