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A 65 y/o man with presents to your office with complaints of exertional chest pain for the past 4 weeks. The chest pain is usually left sided, occurs on walking about one block and goes away with rest. He denies any chest pain now. He also reports no change in quality or intensity of his chest pain He also reports having been diagnosed with peripheral arterial disease about 2 months ago for which he was advised exercise therapy. He does experience leg pain on walking about one block which also improves with rest. His past medical history is significant for moderate COPD, Hypertension and a hernia repair about 3 years ago. His medications include lisinopril, hydrochlorthiazide and tiotropium inhaler. Physical examination is benign. The next best step in establishing the diagnosis in this patient is :
A) 2 D -Echocadiogram
B) Exercise Stress Test ( Treadmill Stress Test)
C) Dobutamine Stress Echocardiogram
D) Persantin Stress Test
E) Cardiac Catheterization
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C
Doubt amine -ionotropic stress test needed
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Why not start with simple Treadmill stress test - it's a stable angina.
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He has intermittent claudication
it precludes him from doing stress test right ?
clarify
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doesnt it precludes from doing exercise stress test
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But he still walks and is able to walk for one block before pain starts just as with chest pain.
What is the answer?
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Here is what I found about contraindications.
Absolute contraindications
Acute myocardial infarction (within 2 d)
Unstable angina not previously stabilized by medical therapy: Appropriate timing of tests depends on the level of risk of unstable angina as defined by the Agency for Health Care Policy and Research Unstable Angina Guidelines.
Uncontrolled cardiac arrhythmias causing symptoms or hemodynamic compromise
Symptomatic severe aortic stenosis
Uncontrolled symptomatic heart failure
Acute pulmonary embolus or pulmonary infarction
Acute myocarditis or pericarditis
Acute aortic dissection
Relative contraindications: Relative contraindications can be superseded if the benefits of exercise outweigh the risks.
Left main coronary stenosis
Moderate stenotic valvular heart disease
Electrolyte abnormalities
Severe arterial hypertension: In the absence of definite evidence, the committee suggests an SBP of greater than 200 mm Hg and/or a DBP of greater than 110 mm Hg.
Tachyarrhythmias or bradyarrhythmias
Hypertrophic cardiomyopathy and any other forms of outflow tract obstruction
Mental or physical impairment leading to an inability to exercise adequately
High-degree atrioventricular (AV) block
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I THINK ANSWER IS DOBUTAMINE SRESS TEST,as this pt has vascular claudication.
anyone please correct me if i am wrong.
