A 58-year-old man comes to see you for a check-up six weeks after an anterior MI. He has had no further episodes of chest pain or breathlessness but is feeling extremely tired. Cardiovascular examination is essentially normal, with no evidence of cardiac failure. He admits to feeling low over the past month, and is having difficulty sleeping. He has a poor appetite. He feels very anxious about the future, and is avoiding the company of work colleagues and friends. He says he cant see the point in anything. He had a similar episode about 10 years ago, which responded well to a low dose of amitriptyline. Which one of the following would be the most appropriate management plan for this patient? (Please select 1 option) Ask him to complete a PHQ-9 form to assess the extent of his low mood, and bring him back in two weeks to discuss the results and review him Reassure him that many people feel low after suffering a heart attack, and that this should gradually improve. Encourage him to resume his normal activities Start him on low dose amitriptyline, as this worked well for him previously, and its sedative effects would be useful in managing his insomnia Stop his beta-blocker medication, as this is probably what is making him so tired Suggest he starts taking sertraline, and review him within the next two weeks
Posted on: Mon, 08 Sep 2014 07:43:54 +0000
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