In the assessment of a patient with stable angina, what is the most appropriate initial diagnostic step?

When assessing a patient with stable angina, the most appropriate initial diagnostic step is a nuclear stress test. This diagnostic tool is particularly useful for evaluating coronary artery disease, as it assesses the blood flow to the heart muscle during stress, helping to identify areas with reduced blood supply that may indicate significant coronary artery blockages.

In patients with stable angina, identifying the extent and effect of ischemia is crucial for determining further management. A nuclear stress test provides functional information about how well the heart is perfused during increased demands, making it a practical choice for initial evaluation.

The other options, while potentially valuable in certain contexts, are not typically the first-line approach for stable angina. Cardiac catheterization is invasive and usually reserved for cases where there is a significant risk of coronary artery disease or when other tests indicate the necessity of direct intervention. A CT angiogram can provide detailed information about the coronary arteries but may not be the best initial step due to its radiation exposure and the need for further evaluation afterward. An echocardiogram can demonstrate structural and functional heart issues but is generally used after initial stress testing to provide more specific information on heart function or structural abnormalities.