q160 - sami2004

[ArchivalUser]

A 72-year-old man with a history of myocardial infarction 10 years ago and angina presents with complaints
of recurrent chest pain, which he has been experiencing over the past 4 months. This pain is retrosternal,
is brought on by exertion, and is relieved by rest. The patient has been taking aspirin, longacting
diltiazem, simvastatin, atenolol, and isosorbide dinitrate at maximal doses. His blood pressure is
130/80 mm Hg; pulse, 62 beats/min; and respirations, 16 breaths/min. Physical examination is normal.
ECG shows normal sinus rhythm, with left bundle branch block.
Which of the following tests would be most useful in the evaluation of this patient's angina?
❏ A. Exercise treadmill ECG
❏ B. Exercise treadmill cardiac nuclear imaging
❏ C. Exercise treadmill echocardiography
❏ D. Dobutamine echocardiography
❏ E. Cardiac catheterization

[ArchivalUser]

E.......

[ArchivalUser]

bbb

[ArchivalUser]

a.

[ArchivalUser]

ee

[ArchivalUser]

e.

[ArchivalUser]

a.

[ArchivalUser]

This patient has known coronary artery disease and angina that is refractory to maximal
medical management. The diagnosis of angina is firmly established with high probability
because this patient has known coronary artery disease and typical symptoms. The
patient's baseline ECG has left bundle branch block, and therefore, exercise stress testing
is not interpretable. Exercise treadmill cardiac nuclear imaging, exercise treadmill echocardiography,
and pharmacologic stress echocardiography all have higher specificity and sensitivity
than conventional exercise tolerance testing and give information about functional
anatomy. However, the most useful test for this patient would be cardiac catheterization,
because he has symptoms despite maximal medical management, is therefore highly likely
to need revascularization, and needs to have his cardiac vascular anatomy defined with
cardiac catheterization. (Answer: E—Cardiac catheterization