# A nurse is assessing a 58-year-old male patient admitted with chest pain. Which assessment finding would be most indicative of coronary artery disease? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=176929 > language: ko > subject: Adult Health ## 문제 A nurse is assessing a 58-year-old male patient admitted with chest pain. Which assessment finding would be most indicative of coronary artery disease? ## 보기 1. Chest pain that worsens with exertion and improves with rest **✔ 정답** 2. Sharp, stabbing chest pain that changes with position 3. Continuous burning sensation in the epigastric area 4. Intermittent palpitations without associated chest discomfort **정답: 1** ## 해설 Chest pain that worsens with exertion and improves with rest is classic for stable angina, indicating coronary artery disease. Other options describe atypical chest pain not specific to CAD. ## 심화 해설 Correct Answer Analysis The assessment finding most indicative of coronary artery disease (CAD) is chest pain that worsens with exertion and improves with rest. This symptom pattern is the clinical hallmark of stable angina, which represents a predictable imbalance between myocardial oxygen supply and demand [1]. The underlying pathophysiology involves fixed atherosclerotic narrowing of the coronary arteries. At rest, the narrowed vessel may still deliver sufficient oxygen to meet the myocardium's baseline needs. However, during exertion or emotional stress, heart rate, contractility, and left ventricular wall tension increase, thereby elevating myocardial oxygen demand. The stenotic vessel cannot adequately dilate to increase blood flow, resulting in myocardial ischemia. This ischemia triggers the characteristic discomfort, which resolves when the activity stops and oxygen demand returns to baseline [1]. Distinguishing Features from Other Options The other options describe pain characteristics more consistent with non-ischemic or non-cardiac etiologies. Option 2: Sharp, stabbing chest pain that changes with position This description suggests a pleuritic or musculoskeletal origin. Pain from pericarditis may also change with position (often relieved by leaning forward). Cardiac ischemic pain is typically described as pressure, tightness, or squeezing rather than sharp and stabbing, and it is not altered by positional changes. Option 3: Continuous burning sensation in the epigastric area A continuous burning sensation points toward a gastrointestinal etiology, such as gastroesophageal reflux disease (GERD). While cardiac ischemia can occasionally present with epigastric discomfort (an anginal equivalent), the key differentiator is the temporal pattern. Ischemic pain is typically episodic and linked to exertion, not continuous and unrelenting [1]. Option 4: Intermittent palpitations without associated chest discomfort Palpitations are a nonspecific symptom that may arise from anxiety, stimulant intake, or primary arrhythmias. In the absence of chest discomfort or a clear exertional link, isolated palpitations are not a primary indicator of obstructive CAD. The risk factor-weighted clinical likelihood (RF-CL) model recommended by the 2024 ESC guidelines emphasizes symptom characteristics—specifically the relationship to exertion—as a critical component in estimating the pre-test probability of obstructive CAD . Clinical Reasoning and Triage Implications Recognizing this classic pattern is essential because stable angina is often one of the earliest clinical indicators of underlying CAD [1]. The nurse's accurate assessment directly informs the clinical likelihood estimate, which determines the next steps in diagnostic testing. Current evidence supports using structured pre-test probability tools, such as the RF-CL model, which combine age, sex, and symptom characteristics with clinical risk factors to guide decisions about further anatomical or functional testing . A patient presenting with predictable, exertional chest pain that is relieved by rest has a higher pre-test probability of obstructive CAD and warrants prompt diagnostic evaluation, whereas a patient with atypical features may be safely stratified to a lower-risk pathway .References (research sources) - [1]Stable AnginaResearch articleGillen C, Shams P, Goyal A. (2026) ## 임상 시나리오 Stable Angina AssessmentRecognizing the hallmark pattern of coronary artery disease The most telling sign of coronary artery disease is chest pain that predictably worsens with exertion and improves with rest. This is the clinical hallmark of stable angina. The underlying mechanism is a fixed atherosclerotic narrowing of a coronary artery. At rest, blood flow may be sufficient, but during activity, myocardial oxygen demand increases and the stenotic vessel cannot dilate enough, causing ischemia and pain. CautionIschemic pain is typically described as pressure, tightness, or squeezing, not sharp or stabbing. Pain that changes with position or breathing points away from a cardiac origin and toward a musculoskeletal or pleuritic cause. ## 핵심 개념 - **Stable Angina** — Chest pain or discomfort caused by myocardial ischemia due to fixed coronary artery narrowing, predictably triggered by exertion and relieved by rest. - **Myocardial Oxygen Demand** — The amount of oxygen the heart muscle requires, determined by heart rate, contractility, and left ventricular wall tension. - **Atherosclerosis** — The process of plaque buildup consisting of fat, cholesterol, and other substances inside the arteries, causing them to narrow. - **Pleuritic Pain** — Sharp chest pain that worsens with breathing or coughing, typically originating from inflammation of the pleura. - **GERD** — Gastroesophageal reflux disease, a digestive disorder where stomach acid frequently flows back into the esophagus, often causing a burning sensation. ## 같은 주제 문제 - [A nurse is assessing a 65-year-old female patient admitted with suspected coronary artery …](https://mymerci.kr/pages/nclex_q.php?qn_id=176928) - [A nurse is caring for a 58-year-old male client with acute coronary syndrome who presents …](https://mymerci.kr/pages/nclex_q.php?qn_id=176932) - [A nurse is caring for a 58-year-old male client with acute coronary syndrome who presents …](https://mymerci.kr/pages/nclex_q.php?qn_id=176934) --- More free questions: [기출문제](https://mymerci.kr/) _학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._