The following case study will be referenced at the upcoming Cardiovascular Disease Management: A Case-Based Approach, 3rd Annual Symposium, which will take place October 1-2, 2015 at the historic Arizona Biltmore Hotel in Phoenix, Arizona.
Dr. Heuser is interested in your approach. Let us know how you would treat the patient in the comments below.
A 32-year-old woman comes in with recurrent visits to the emergency room for chest pain. The pain is substernal but is sometimes associated with nausea and belly pain. She denies any diaphoresis or dyspnea. Her risk factors for coronary disease include: Family history of early sudden death in a brother in his 40s. Her physical examination reveals her blood pressure to be 100/70, her pulse is 70 and regular. The rest of her physical examination is normal. Her BMI is normal and her labs are completely normal. How would you evaluate and manage this patient?
For the detailed program, registration, CME, and hotel information for CDM 2015, please visit: http://promedicacme.com/meeting/Cardiovascular-Disease-Management-A-Case-Based-110.html.
As this lady has been coming repeatedly for what seems to be angina I suggest a dobutamine stress echo including strain evaluation. If this appears to be normal at 130 beats per minute I would increase the heart rate to 150 beats per minute and check regional wall motion and strain again. In case of pathologic wall motion or strain I would proceed to coronary angiography. In case of completely norma stress echo I would have my gastroenterology colleague see the patient.
Great suggestions!