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Chronic Stable Angina

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20120805

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Chronic Stable Angina




A 60-year-old man has known CAD for many years and has had multiple cardiac catheterizations and two stents. His last cath was six months back after a borderline positive stress test. The cath revealed that his stents were widely patent and that his other proximal coronaries had non-obstructive disease; he has diffuse disease distally- but these were non-revascularisable by intervention or CABG and needed to be medically managed. His Ejection fraction is normal.

He gets angina on moderate to severe exertion but it gets relieved by resting. He uses 2-3 sublingual Nitroglcerine pills per month. The frequency of the Chest pain has not changed for over a year.

He takes Aspirin, Isosorbide mononitrate, Lopressor, Lipitor and Lisinopril daily. His BP is well controlled. His LDL is 75mg/dl. He has no Diabetes and he doesn’t smoke. He is moderately active.

He is being evaluated for hernia surgery and mentions one episode of angina to his nurse during the pre-op anesthesia evaluation. He is given a sublingual NTG which relieves the chest pain completely. (He did not take his AM meds for his blood tests.


1.What is his diagnosis?
2.What is the pathophysiology of his condition?
3.Should he be admitted for his angina (R/o MI protocol)?
4.Can he undergo his hernia repair surgery?
5.What peri-operative advice would you give his surgeon / anesthesiologist?

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