03-12-2008, 08:33 PM
A 32-year-old woman is brought to the hospital with chest pain at rest after a party. She has had similar pain previously, primarily in the morning and rarely with exertion. The pain usually subsides spontaneously and occasionally is associated with diaphoresis but rarely dyspnea. She almost lost consciousness at work during the most recent episode. She smokes a half pack of cigarettes a week and has occasionally inhaled cocaine. She is otherwise healthy and takes no medications. She has no family history of coronary artery disease.
Her blood pressure is 128/70 mm Hg and pulse rate is 72/min. There is no neck vein distention or carotid bruits. The lungs are clear and cardiac examination reveals a normal S1 and S2 and a faint mid-systolic click but no murmur. Examination of the abdomen and extremities is normal. Electrocardiogram shows a 1-mV inferior ST-segment elevation; a subsequent electrocardiogram is normal. Serum troponin concentration is 1.5 times the upper limit of normal. Therapy with heparin, aspirin, metoprolol, and nitroglycerin is begun. The next morning, coronary angiography shows normal angiographic appearance of the arteries and normal left ventricular wall motion. The patient is prescribed a daily aspirin and encouraged to stop using cocaine.
What additional medical therapy should be prescribed at discharge?
A Angiotensin-converting enzyme inhibitor
B β-blocker
C Calcium-channel blocker
D Clopidogrel
Her blood pressure is 128/70 mm Hg and pulse rate is 72/min. There is no neck vein distention or carotid bruits. The lungs are clear and cardiac examination reveals a normal S1 and S2 and a faint mid-systolic click but no murmur. Examination of the abdomen and extremities is normal. Electrocardiogram shows a 1-mV inferior ST-segment elevation; a subsequent electrocardiogram is normal. Serum troponin concentration is 1.5 times the upper limit of normal. Therapy with heparin, aspirin, metoprolol, and nitroglycerin is begun. The next morning, coronary angiography shows normal angiographic appearance of the arteries and normal left ventricular wall motion. The patient is prescribed a daily aspirin and encouraged to stop using cocaine.
What additional medical therapy should be prescribed at discharge?
A Angiotensin-converting enzyme inhibitor
B β-blocker
C Calcium-channel blocker
D Clopidogrel