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* confusions in UW Qs ??
  pakipower - 11/23/06 19:46
  In one of the Q they say that a pt comes to you with a typical presentation of exertional Angina ... whats the next best step to do ???
answer given is STRESS EKG... now the problem is this patient came to you for the first time, the best intial investigation must be EKG at that moment and once its inconclusive then go for a stress EKG ?????

comments plz
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* Re:confusions in UW Qs ??
  drzx - 11/24/06 08:38
  i think the correct answer depends on the choices available and as usual the best next step or the diagnostic test and the presentation of the patient.
If the patient comes with h/o exertional angina and now is not with any symptoms then it seems to be a reversible ischemia, ekg will not show anything now, so the ideal way to diagnose IHD in this patient will be to stress him.....ekg stress test.
But if he comes with any symptoms then immediate ekg is needed as u can now expect ischemic changes now but if u fail to find any but still suspect IHD then go ahead with stress test.
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* Re:confusions in UW Qs ??
  tea - 11/24/06 09:13
  classic stable angina-exertional CP, CP will not last more than 15 mins (5mins-most common)in most of the cases. Hardly see patients coing with ongoing CP in the office ,even in ED, most co0me in with a complain of history of exertional CP episodes. but rarely has abnormal findings at the time, including ECG. since typical stable angina itself already has high pre-test probability, so stress test -nuclear neither for Dx nor for R/O for typical cases, but can access the severity and prognosis. Most beneficial stress test for stable agina is those atypical symptoms -intermitten(inconclusive)-ECG , then exercise or chemical induced-ischemic during the stress test to discover the ture ischemic from ECG changes during the test, then nuclear scan to confirm the the ture schemic. If it is ture ischemic, next to do angiogram to estimate % of blokcage and which cornoary artery(s) involve, then decide if it is worth to any intervention, as stents also risk of restenosis and open-up the blocked-(diseased), physiologically increase the blood flow to the diseased vessel(you fixed it) but meanwhile you loss the collate smaller vessels' blood flow, it result in lossing these vessels (close up, as all blood flow to the diseased vessel you opened with PCI or angioplasty.  
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