A 53-year-old man with multiple atherosclerotic risk factors, including HTN, hyperlipidemia, and tobacco use, presents with a 6-month history of DOE and exertional chest tightness. He has orthopnea and paroxysmal nocturnal dyspnea.
Echocardiography reveals a severely dilated LV with an EF of 20% and global ventricular hypokinesis. The ECG is normal.
The next step in diagnostic evaluation should be:
a. Holter monitor
b. Stress test with measurement of maximal oxygen consumption
c. Coronary angiography
d. Heart transplant evaluation
Answer c:
This patient is at high risk for CAD since he has multiple CV risk factors, cardiomyopathy,
and apparent angina. Thus, coronary angiography should be preferred and noninvasive
stress bypassed. A Holter monitor and transplant evaluation are not clinically
warranted at this time.
Echocardiography reveals a severely dilated LV with an EF of 20% and global ventricular hypokinesis. The ECG is normal.
The next step in diagnostic evaluation should be:
a. Holter monitor
b. Stress test with measurement of maximal oxygen consumption
c. Coronary angiography
d. Heart transplant evaluation
Answer c:
This patient is at high risk for CAD since he has multiple CV risk factors, cardiomyopathy,
and apparent angina. Thus, coronary angiography should be preferred and noninvasive
stress bypassed. A Holter monitor and transplant evaluation are not clinically
warranted at this time.
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Radiology