Add: new stable coronary artery disease management question for outpa…

…tient scenarios

questions/cardiology/outpatient/stableCAD.md

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+---
+id: CARD017
+specialty: cardiology
+topic: coronary artery disease
+difficulty: medium
+tags: [cardiovascular, outpatient, chronic, pharmacology, copilot01]
+created: 2025-01-10
+lastUpdated: 2025-01-10
+---
+
+# Stable Coronary Artery Disease Management
+
+## Question
+A 62-year-old man with known coronary artery disease presents for medication adjustment. His history includes:
+
+Medical History:
+- Prior NSTEMI 2 years ago with PCI to LAD
+- Type 2 diabetes (A1c 7.1%)
+- Hypertension
+- LDL 110 mg/dL on moderate-intensity statin
+
+Current Status:
+- CCS Class II angina (symptoms with moderate exertion)
+- 2-3 episodes per week, responsive to sublingual nitroglycerin
+- Good medication compliance
+
+Vital Signs:
+- BP: 142/88 mmHg
+- HR: 72/min
+- RR: 16/min
+- BMI: 27 kg/m²
+
+Current Medications:
+- Aspirin 81mg daily
+- Atorvastatin 40mg daily
+- Metoprolol succinate 50mg daily
+- Lisinopril 20mg daily
+- Metformin 1000mg BID
+
+Which medication change would be most appropriate?
+
+## Options
+| Option | Description |
+|--------|-------------|
+| A)     | Add ranolazine |
+| B)     | Increase atorvastatin to 80mg |
+| C)     | Switch to carvedilol |
+| D)     | Add long-acting nitrate |
+| E)     | Add second antiplatelet |
+
+<details>
+<summary>View Answer</summary>
+
+## Correct Answer
+B
+
+## Explanation
+This case demonstrates key concepts in stable CAD management:
+
+1. Why Increase Statin is Optimal:
+   - LDL above secondary prevention goal (<70 mg/dL)
+   - High-risk patient (diabetes + prior MI)
+   - Room for dose escalation
+   - Guidelines strongly recommend maximizing statin
+
+2. Why Other Options Are Less Appropriate:
+   - A) Ranolazine: Reserved for refractory symptoms
+   - C) No clear advantage of carvedilol over metoprolol
+   - D) Long-acting nitrates not first-line for occasional angina
+   - E) DAPT typically not extended beyond 1 year post-PCI
+
+3. Additional Considerations:
+   - BP needs better control
+   - Diabetes well-controlled
+   - Appropriate use of evidence-based medications
+   - Regular exercise should be encouraged
+
+4. Secondary Prevention Goals:
+   - LDL <70 mg/dL
+   - BP <130/80 mmHg
+   - A1c <7%
+   - Regular exercise
+   - Smoking cessation (if applicable)
+
+## References
+- ACC/AHA Guidelines for Stable CAD 2022
+- ESC Guidelines on Chronic Coronary Syndromes 2023
+- JACC: Secondary Prevention of ASCVD 2022
+</details>