Cardiology>>>>>Ischaemic heart disease
Question 8#

You are referred a 40-year-old lady with left arm pain. She had a single episode after running for a bus with shopping, which subsided after 5 minutes. She has never previously had exertional chest discomfort. Resting ECG is normal and 8 hours high-sensitivity troponin is negative. She has a BMI of 33 and diet-controlled type 2 diabetes mellitus but is not hypertensive.

What do you recommend?

a. Reassure and discharge
b. Inpatient invasive coronary angiogram
c. Outpatient stress echo
d. Discharge-dependent exercise treadmill test
e. CT coronary angiogram

Correct Answer is C


This woman has an intermediate risk of coronary artery disease (30–60%). She has had a single episode of possible angina but ACS is ruled out. A functional test (stress echo, stress MRI, or nuclear perfusion scan) is the most appropriate form of risk stratification and this can be completed as an outpatient.