Q1  (question repeated - answer below)

A 63 year old diabetic patient comes to your office complaining of Chest discomfort, occurring after he eats. He smokes a pack of cigarettes a day. He was talking with a nurse friend of his who suggested that he have a stress test. On further questioning you find out that he has cramping pain in his legs when he walks 100 yards but it is promptly relieved upon resting. His only medication is Albuterol (Salbutamol is called Albuterol in the USA) inhaler that he uses no more than twice a day.

Your advice to him should consist of which ONE the following choices:

1. He should take an aspirin a day and that might relieve him.
2. He should be immediately sent to the ER for further workup of his chest discomfort
3. Further testing is not required but he should be started on Omeprazole for 1 month.
4. Smoking might be causing this and he should quit this.
5. Start an aspirin and get stress testing done as an out-patient.

Answer : e

This patient has stable angina. Even though this is the first time someone made the diagnosis, this his not his first episode. He also does not have crescendo angina.

He should thus be started on ASA and called back for a stress test.

Because of the atypical nature of his symptoms, a cardiac cath should not be the first investigation. Had his symptoms been typical, one would directly ask for a cath without the need for a stress test.

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