a 62 year old women omes to physician with tightne - biryani

[ArchivalUser]

a 62 year old women omes to physician with tightness in chest over her anterior chest during brisk walking. she has episodi symptoms for previous 6 months, sometimes associated with sob. discomfort lasts `0-15 minutes and feels like muscle cramps. pt has h/o DM, and anxiety.. current meds are simvastatin and low dose aspirin...bp is 135/90 and pulse is 72/min. BMI 29. Physical exam unremarkable. office ecg shows sinus rythm with t wave inversion in leads avL and v1. which of the following is the most appropriate next step in management?

a. coronary angio
b Exercise stress test
c. echo
d. clopidogril and metoprolol
e. nitrate therapy

[ArchivalUser]

B. Exercise stress test. This is a normal ECG ( T wave is normally upright in leads I,II, V3,V6; inverted in aVR; variable in d rest). The patient seems to have stable angina: EKG if normal> stress test,if abnormal>Angiography

[ArchivalUser]

B.EST

[ArchivalUser]

but the patient is 62, has hypertension, DM--->considered high risk..
why not A.

high pre test CHD----Angio?

[ArchivalUser]

any other input

[ArchivalUser]

http://ecg.utah.edu/lesson/11
The ECG in the vignette is normal as stated in prior discussion.

MTB - 3
Dr. Fisher says do not do angio unless stress test is abnormal.

Patient may need angio but should be directed by stress test.

Agree completely with first response.

[ArchivalUser]

however in usmle world

they state that if patient is a high pre test probability of CHD you can go straight to angio