![]() This patient does not fit into any of these categories (his ejection fraction on echo is 55%). The indications for prescribing an ACE inhibitor in a patient with stable angina are: Both drugs carry a risk of hemorrhage, though the risk is greater with eptifibatide than with tirofiban.Ĭhoice D: Lisinopril is incorrect but brings up a very good high-yield point for the USMLE: When to give an ACE inhibitor to a patient with stable angina. When given to patients post-PTCA, they reduce the risk of stent re-stenosis. ![]() They act as glycoprotein IIb/IIIa inhibitors and have a pronounced antiplatelet effect. ![]() These drugs are used for acute coronary syndrome. Why the other answers are wrong Why the other answers are wrongĬhoices A and B: Eptifibatide, percutaneous transluminal coronary angioplasty and tirofiban are incorrect because there is no statistically significant data to suggest that giving tirofiban or eptifibatide lowers mortality in stable angina. Eptifibatide and then perform a percutaneous transluminal coronary angioplasty. What is the next best step in management?Ī. Echocardiogram reveals an ejection fraction 55 percent. However, he states that his productivity at the farm has increased. Two months later the patient returns and is still experiencing chest pain during exercise. He is also started on atorvastatin and advised to implement a low-fat diet. A 12-hour fasting serum LDL cholesterol concentration is 140 mg/dL. Stress test reveals ST-segment depression in leads I, aVL, V4, V5 and V6.Īspirin, nitrates and metoprolol are initiated. His vital signs are temperature 37.0✬ (98.6✯), pulse 74 per minute and blood pressure 135/82 mm Hg. This is severely affecting his work, and he is concerned that he will lose his job because of poor productivity. The pain subsides after about two minutes of rest but quickly returns upon walking again. Over the past eight months, he has noticed a dull, central chest pain that radiates to his left arm and jaw while walking. This month’s stumper This month’s stumperĪ 59-year-old ranch hand presents to the outpatient department with chest pain. ![]()
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