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Medicine question 78 - misshyd
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11-12-2010, 03:08 PM
chest pain - 3months
onset with moderate exercise relieved by rest severe crampy pain legs on exercise - severe PVD ( CI for exercise stress test) given the duration of his chest pain and his PVD - the answer should be D.
11-12-2010, 03:49 PM
with all due respect to dr.red and you misshyd
Yup it may be angina...but many diabetics present with nstemi initially with no chest pain and non specific ST changes....if such patient go to stress test without excluding MI those patient might collapse during the test. How can we be sure in diabetics that its not MI . unless we do cardiac enz. considering diabetic ..here is the reference from oxford journal ...please have a look misshyd whether they clearly say that Diabetics with non specific ST change shud undergo cardiac enzymes on presentation. please have a look waiting for your feedback.
03-16-2011, 09:11 PM
I would go with D also...
Cardiac enzymes would be appropriate if he was having chest pain at present. Remember cardiac enzymes will only help you rule out INFARCTION not angina symptoms. He needs further workup for his stable angina, which would include an exercise stress test (if able to do so), since he is 65 and having leg pain he likely wont be able to tolerate this. So i would go with D. Answer plz? |
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