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* What is the next diagnostic step for this patient?
 #837533  
  mounika1980 - 02/17/17 13:03
 
  55-year-old man with a past medical history significant for diabetes for 15 years presents to your office complaining of increasing shortness of breath over the past few months. Although he is pain-free today, he has had angina-like chest pain over the last several months. There is no radiation of the pain or nausea, vomiting, or diaphoresis. The patient's medications consist of metformin, glyburide, and lisinopril. He denies alcohol, tobacco, or illicit drug use.

On physical examination, the patient appears as an age-appropriate obese male. Blood pressure is 170/130 mm Hg, and heart rate is 66/min. Jugulovenous distention is present. There is an S3 gallop with lateral displacement of the point of maximal impulse and some minimal rales at the lung bases. There is no peripheral edema. An EKG reveals a normal sinus rhythm at a rate of 64/min with no ST elevation and no T wave inversions. Anterior and inferior leads have QS waves. An echocardiogram reveals four chamber dilatation, global hypokinesis, and an ejection fraction of 35%.

What is the next diagnostic step for this patient?

(A) Coronary angiography

(B) 24-hour Holter monitor

(C) Transesophageal echocardiogram

(D) Thallium stress test

(E) Endomyocardial biopsy
 
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* Re:What is the next diagnostic step for this patie
#3328489
  keloke - 02/17/17 18:50
 
  D , Thallium stress test  
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* Re:What is the next diagnostic step for this patie
#3328689
  dheeraj - 02/19/17 23:35
 
  b
global hypokensis - pt is damed , needs to find out is any vasscular inetrvention -stent vs cabg inprove perfusion and place aicd
 
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