A 35-year-old male with no past medical history - abrahem

[ArchivalUser]

A 35-year-old male with no past medical history presents with severe substernal chest pain while at rest for 2 h with associated shortness of breath and vomiting. His only habit is tobacco abuse, and he takes no medications. Physical exam shows normal vital signs, and cardiac and pulmonary exams are normal. An electrocardiogram shows ST-segment elevation in leads V1 through V4. Cardiac catheterization is performed and shows spasm in the left anterior descending artery that is relieved with intracoronary nitroglycerine. Which of the following statements is correct?

A. This patient with Prinzmetal's angina is unlikely to have any significant stenoses in the coronary arteries.
B. The left anterior descending artery is the most common site for focal spasm in patients with Prinzmetal's angina.
C. Hyperventilation can be used to provoke transient ST elevation and coronary spasm in patients with Prinzmetal's angina.
D. Medical management of this patient should include beta blockers.
E. Aspirin is indicated to decrease the severity of ischemic episodes.

[ArchivalUser]

c

asaprin is used in unstable angina (angina at rest) bc due to platlet clots, so u want to decrease platlet aggregation, also use ccb's

you dont want to use bb's.

[ArchivalUser]

A?

[ArchivalUser]

agree with rumrum

[ArchivalUser]

yes it's C

[ArchivalUser]

asaprin is used in unstable angina (angina at rest)

from the question stem it is unstable angina, why don't use asaprin?

[ArchivalUser]

what is the diagnosis?

[ArchivalUser]

stable angina (exertional, typical, classic, angina of effort)
due to atheroscleorsis and episodes ofprecipateted by exercise, cold, stress, emotion, eating

Vasospastic angina (variant, prinzmetal)
chest pain at rest
vasospastic of coronary vessles
txt with nitrates and ccb's

Unstable angina (angina at rest)
due to platelet clots so u want to decrease platlet aggregation by giving ccb's and asa

[ArchivalUser]

The answer is C.



Prinzmetal's, or variant, angina is defined by transient epicardial coronary artery vasospasm with subsequent electrocardiographic abnormalities that include ST-segment elevation or depression. In the majority of patients with this disorder, there is significant coronary stenosis within at least one major vessel and the spasm occurs within 1 cm of the obstruction. The most common site of focal spasm is the right coronary artery. Epidemiologically, patients with variant angina are younger and have fewer coronary risk factors and lack preceding chronic stable angina. Patients with this as a suspected diagnosis can undergo provocative maneuvers to elicit the electrocardiographic or angiographic changes. Of note, hyperventilation ergonovine, acetylcholine, and other vasoconstrictors have been used. The mainstays of therapy are nitrates and calcium channel blockers to promote vasodilation and prevent spasm. Aspirin is thought to increase the severity of ischemic episodes and is relatively contraindicated.