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Transcript of Stable Angina
Physiology & Case
Myocardial Oxygen Supply
Myocardial Oxygen Demand
1. Why not stop the Alendronate?
2. What is the difference between stable and unstable plaque?
3. (T/F) A CCS is the gold standard of cardiovascular exams
(CT & Angiogram)
"5 Heart Tests That Can Save Your Life." Gwinnett Medical Blog. Gwinnett Health System, Inc.,12 Dec. 2012. Web. 20 Sept. 2014.
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"Coronary Artery Calcium Scoring." Wilson-White Medical Center Online. Wilson-White Medical Center, n.d. Web. 21 Sept. 2014. <http://www.white-wilson.com/>.
Gedik, Hülya Ü. "Myocardial Infarction." Prehospital Emergency Care for Heart-related Problems.Web. 20 Sept. 2014.
Gómez V, Xiao S-Y (2009) Alendronate-induced esophagitis in an elderly woman. Int J Clin Exp Pathol 2(2):200–203
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Lilly, Leonard S. "Determinants of Myocardial Oxygen Supply and Demand." Pathophysiology of Heart Disease: A Collaborative Project of Medical Students and Faculty. Baltimore, MD: Wolters Kluwer/Lippincott Williams & Wilkins, 2011. Print.
Ramanathan, Tamilselvi, and Henry Skinner. "Http://ceaccp.oxfordjournals.org/content/5/2/61.full." Coronary Blood Flow. BJA: CEACCP. Web. 20 Sept. 2014.
"Resin Cast of Coronary Arteries of the Human Heart Photographic Print by Ralph Hutchings at AllPosters.com." Photography. AllPosters.com. Web. 20 Sept. 2014.
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(Courtesy of White-Wilson Medical Center)
Diagnosed with osteoporosis two months prior, the patient has taken her Alendronate once weekly in the morning. The epigastric pain she experienced also occurred occasionally in the morning, suggesting causation. The patient should be asked
if she took the Alendronate the same day
that her epigastric pain occurred, and if so –
did she properly hydrate
while doing so? Her labs are not suggestive of further progression in CAD.
Alendronate has been reported to cause erosive or ulcerative esophagitis
without proper water intake. Patient should be advised to take this medication, “
with a full glass of water at least 30 minutes before
the first oral intake of the day, and to remain in an
upright position for a minimum of 30 minutes afterward
”, to avoid further pain.
Medication Hx: Calcium carbonate 1200 mg qAM, Centrum Silver Women vitamin qAM, Aspirin 81 mg qAM, Lovastatin 20 mg tablet qPM,
Alendronate 70mg tablet weekly in AM
, Tums for occasional heartburn
Exam: Ht: 5’6’’, Wt: 180 lbs, Waist 38” (T2D risk), BMI: 29.0 (overweight), BP: 135/78 sitting (preHTN)
Labs: Slightly elevated sodium (Na 144 mEq/L), slightly elevated glucose (105 mg/dL),
coronary calcium scan score of 150 (mild to moderate plaque burden), 55% stenosed in proximal LAD
Other exams/labs: WNL
CC: JT is a 62 yo woman presenting
substernal “heaviness” which radiated to her epigastrium occasionally in the mornings
and felt “different” than usual pain.
HPI: Former “squeezing” chest pain (x3 days) was felt post-exertion, such as climbing stairs, did not radiate, was accompanied by diaphoresis, and subsided minutes after ceasing activity. This pain was indicative of stable angina and coronary artery disease.
OPO (Dx 2 mo ago)
, Dyslipidemia (Dx 2 yr ago)
SH: Retired middle-school teacher with three children. Smoked 1 ppd x20 yrs, quit at 41 yo. Occasional red wine, admits to “poor” diet of high salt and fat, low fruits and vegetables. No regular exercise.
FH: Father died of AMI at 62 yo. Mother died of CHF at 75 yo. Sister, 68 yo, has HCL and HTN.
(Courtesy of Ramanathan et. al)
(Courtesy of Dr. Wayne LeMorte)
(Courtesy of Drs. Klabunde & Gedik, respectively)
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