----- Original Message -----
From: "Sam Waddy"
> New onset angina therefore unstable. So admit, fragmin, aspirin, 12
> hourly troponin (if the above wasn't) assuming no further chest pain,
> troponin not diagnostic for MI then exercise test, if negative home,
> follow up in 6 weeks, if positive keep as in patient, continue aspirin,
> fragmin, beta blockade, await inpatient angiogram. Probably start a
> statin as well.
> At least that is what I would do as a medical SHO.
> Sam Waddy
Bullshit, new onset does not automatically mean unstable; this is stable
angina and even stable angina has to have an "onset" sometime! I wouldn't
admit this sort of patient; GPs regularly manage this sort of patient in the
community as they don't often present to A&E departments. I would start her
on a nitrate in the first instance, plus aspirin, and arrange cardiology opd
review. My GP colleagues may well investigate her lipid profile etc, but I
don't normally go down that route as part of emergency management.
Adrian Fogarty
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