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A 70-something female with no previous cardiac history presented with acute chestpain. She awoke from sleep last night around 4:45 AM (3 hours prior to arrival) with pain that originated in her mid back. She stated the pain was achy/crampy. Over the course of the next hour, this pain turned into a pressure in her chest.
Case An 82 year old man with a history of hypertension presented to the ED with chestpain at 1211. He described his chestpain as pleuritic and reported that it started the day prior while swinging a golf club. The ED provider ordered a coronary CT scan to assess the patient for CAD. In lead I, about 1.5
A 34 yo woman with a history of HTN, h/o SVT s/p ablation 2006, and 5 months post-partum presented with intermittent central chestpain and SOB. She had one episode of pain the previous night and two additional episodes early on morning the morning she presented. Deep breaths are painful and symptoms come and go.
Written by Pendell Meyers, edits by Smith and Grauer A man in his late 20s with history of asthma presented to the ED with a transient episode of chestpain and shortness of breath after finishing a 4-mile run. Ct coronaryangiogram showed normal coronary arteries. He typically runs 4 to 8 miles per day.
A 30-something male presented in the middle of the night with several hours of sharp, non-radiating, left sided chestpain. CT coronaryangiogram is excellent , but is rarely available outside of business hours, and hardly ever at night. He is a smoker and has some family history of early MI.
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.
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.
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.
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. IV Diltiazem was Contraindicated!
Here is the coronaryangiogram: A distal thrombotic right coronary artery (RCA) occlusion ! Comment by K EN G RAUER, MD ( 12/22 /2022 ): = Brilliant post by Dr. Aslanger — with emphatic illustration of "the difference in OMI vs STEMI philosophy" — in action! Turk Kardiyol Dern Ars. 2021 Sep;49(6):488-500. 2021.21026.
I don’t understand how the curve of non-cardiac chestpain trespasses in the middle of a Troponin race (False positives? Mind you, even a coronaryangiogram will not bail you out in terms of decision-making and risk prediction. 2022 Oct;38(10):1521-1524. Epub 2022 May 13. Reference 1. Can J Cardiol.
A 69 year old woman with a history of hypertension presented to the emergency department by EMS for evaluation of chestpain and shortness of breath. She awoke in the morning with sharp chestpain which worsened throughout the morning. As her pain worsened, so did her dyspnea. This was written by Hans Helseth.
A 62 year old man with hyperlipidemia presented to a rural emergency department with 7 hours of 3/10 chestpain. Heitner et al found that in 14% of patients with NSTEMI, a blinded interventional cardiologist interpreting coronaryangiograms identified a different culprit artery than CMR ( [link] ).
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