WBR0898

Author	[[PageAuthor::Mohamed Moubarak, M.D. [1]]]
Exam Type	USMLE Step 3
Main Category	Emergency Room
Sub Category	Cardiovascular
Prompt	A 55 year- old male comes to ED after 2 days of experiencing a chest pain. He mentions the attack as a dull pain started 15 min before arriving to ED all over his chest that radiates to the left shoulder and arm, and he was released the next day after being prescribed some medications. Today he comes with the same presentations, with EKG is as before normal. After the resolve of his attack, you ordered a stress test, which turn abnormal and show a reversible ischemia. Which of the following is the best next step in his further management?
Answer A	Angiography
Answer A Explanation	Correct If the stress test shows an area of reversible ischemia, angiography is done as the best next step
Answer B	Echocardiography
Answer B Explanation	Incorrect Echocardiography is the best test to evaluate the valve and wall motion function.
Answer C	Coronary bypass
Answer C Explanation	Incorrect Coronary bypass is done when the result of the angiogram suggest the need to it.
Answer D	Repeat CK-MB
Answer D Explanation	Incorrect The diagnosis is already set, and repeating CK-MB will not add to your management plan.
Answer E	Lipid profile
Answer E Explanation	Incorrect Lipid profile will not establish the diagnosis of CAD, but will be used subsequently to follow up this patient.
Right Answer	A
Explanation	Coronary artery disease (CAD) present with chest pain that doesn’t change with body position and respiration. Stress test is done when the case is equivocal, and you are not certain of the diagnosis. According to ACC/AHA class I recommendations for angiography, if the stress test shows an area of reversible ischemia, angiography is done as the best next step. Educational Objective: References:
Approved	No
Keyword	[[WBRKeyword::Coronary artery disease]]
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