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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.
A 63 year old man with a history of hypertension, hyperlipidemia, prediabetes, and a family history of CAD developed chestpain, shortness of breath, and diaphoresis after consuming a large meal at noon. He called EMS, who arrived on scene about two hours after the onset of pain to find him hypertensive at 220 systolic.
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.
Chestpain or discomfort) What do you think? The total duration of chestpain was 30-45 minutes. I said that this is unstable angina until proven otherwise. Outcome The only followup we got was that the patient is undergoing Coronary Bypass (CABG) of LAD, 2nd Obtuse Marginal, and Left Posterolateral coronaries.
Knowledge of this fundamental pillar of biology should drive how cardiologists approach men and women being evaluated for the presence of significant coronary disease. Atypical angina is classified as having any two of the three symptoms, and non-anginal pain any one of the three symptoms.
But the symptoms returned with similar pattern – provoked by exertion, and alleviated with rest; except that on each occasion the chestpain was a little more intense, and the needed recovery period was longer in duration. It’s judicious, then, to arrange for coronaryangiogram. CoronaryAngiogram 1.
CT coronaryangiogram — No obstructive coronary disease. CT coronaryangiogram showed no obstructive coronary disease. But immediate resolution of chestpain once VT was converted — and — the normal CT coronaryangiogram — essentially ruled out acute coronary disease as the cause.
One big chunk of ACS-UA is secondary UA where there is increased demand as in stable angina with tachycardia*. we can witness menacingly deep resting ST depression with absolutely no thrombotic process going on in the coronary. Mind you, even a coronaryangiogram will not bail you out in terms of decision-making and risk prediction.
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