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Stable angina with high-risk stress imaging — RCPSC IM MCQ

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HardCardiologyStable angina with high-risk stress imagingRCPSC IM

A 64-year-old with ischemic cardiomyopathy and LVEF 35% has limiting exertional angina despite tolerated beta-blocker and long-acting nitrate therapy. Stress imaging shows extensive inducible LAD-territory ischemia at low workload with transient left-ventricular dilation. What is the most appropriate next step?

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Correct answer: C — Refer for coronary angiography and revascularization assessment

The best answer is “Refer for coronary angiography and revascularization assessment”. Persistent symptoms plus high-risk functional findings warrant defining coronary anatomy and considering revascularization alongside optimal medical therapy. Repeat testing or indefinite deferral misses prognostically important disease, lipid control does not remove antiplatelet indication and fibrinolysis is not chronic-angina therapy.

Reference: Canadian Cardiovascular Society, 2021 HFrEF treatment update. https://ccs.ca/news/new-approach-to-heart-failure-therapy-upends-conventional-treatment-saves-lives/