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The patient presented due to chestpain that was typical in nature, retrosternal and radiating to the left arm and neck. He denied any exertional chestpain. It is unclear if the patient was pain free at this time. Use ß-blockers with caution ( as they may aggravate coronary spasm ).
Submitted by anonymous, written by Pendell Meyers A woman in her 50s presented to the Emergency Department with chestpain and shortness of breath that woke her from sleep, with diaphoresis. See these other cases of arterial pulse tapping artifact: A 60 year old with chestpain Are these Hyperacute T-waves? 2010.12.162.
CT Coronary Artery Calcium Score Scan CT Coronary Artery Calcium Score CT CoronaryAngiogram As you can see from the above images, the CTCA provides far more anatomical detail. Regardless, if you present with chestpain and get a stress test instead of a CTCA, you are arguably getting an inferior test.
We look directly at the coronary arteries using a cardiac CT scan. Subscribe now Cardiac CT There are two types of cardiac CT: CT Coronary Artery Calcium (CAC) Scan CT CoronaryAngiogram (CTCA). The CAC scan looks for deposits of calcium in the areas of the coronary arteries as a proxy marker for plaque.
He had concurrent sharp substernal chestpain that resolved, but palpitations continued. Over past 3 months, he has had similar intermittent episodes of sharp chestpain while running, but none at rest. Past medical history includes coronary stenting 17 years prior.
Hospital evaluation for this patient was negative for an acute coronary syndrome ( ie, CT coronaryangiogram was normal — troponin was not elevated — and Echo was negative, with no sign of pericardial effusion ). I interpreted the ECG in Figure-1 as follows: The rhythm is sinus at ~65/minute.
CT coronaryangiogram — No obstructive coronary disease. CT coronaryangiogram showed no obstructive coronary disease. Today's case is illustrative because it shows how high troponin may rise despite the absence of acute coronary occlusion! ( No sign of ARVC.
The best course is to wait until the anatomy is defined by angio, then if proceeding to PCI, add Cangrelor (an IV P2Y12 inhibitor) I sent the ECG and clinical information of a 90-year old with chestpain to Dr. McLaren. All electrocardiograms (ECGs) and coronaryangiograms were blindly analyzed by experienced cardiologists.
Cardiology felt her chestpain to be, most likely, the result of coronary supply-demand mismatch in the context of HCM endothelial remodeling (i.e. Type II MI), however decided to pursue coronaryangiogram out of an abundance of caution. Below are two examples of this. Pacing Clin Electrophysiol. 40; 1234-1241.
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