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Ischemia with no obstructive coronary arteries (INOCA) is an increasingly recognized condition in patients presenting with angina and positive stress tests but without significant coronary artery stenosis. The paper discusses a potential interference between vasodilators used in trans-radial access and coronary spasm testing.
This EKG is diagnostic of transmural ischemia of the inferior wall. If it is angina, lowering the BP with IV Nitroglycerine may completely alleviate the pain and the (unseen) ECG ischemia. Transmural ischemia (as seen with the OMI findings on ECG) is not very common with demand ischemia, but is possible.
Distilling this case into its most salient components, a man with multiple riskfactors for coronary disease is presenting with several days of chest pain and markedly elevated troponin with no other reason to explain the lab abnormality ( e.g. sepsis). This is WHY refractory angina should prompt immediate angiography.
Given the consistency of the clinical profile with typical angina, associated riskfactors, and abnormal ECG findings, a cardiology consult was promptly requested. It should be known that each category can easily manifest the generic subendocardial ischemia pattern. If they all return normal, then this is unstable angina.
I quickly reviewed the patient’s records and saw that she was a 53 year old woman with a history of BMI 40, but no other identifiable riskfactors for coronary artery disease. This proves effective treatment of the recurrent ischemia. The patient had no further symptoms of ischemia. I performed bedside echocardiography.
A middle aged male with no h/o CAD presented with one week of crescendo exertional angina, and had chest pain at the time of the first ECG: Here is the patient's previous ECG: Here is the patient's presenting ED ECG: There is isolated ST depression in precordial leads, deeper in V2 - V4 than in V5 or V6. There is no ST elevation.
ET Main Tent (Hall B1) This session offers more insights from key clinical trials presented at ACC.24 24 and find out what it all means for your patients.
No riskfactors, leads a healthy lifestyle. No riskfactors, leads healthy lifestyle. This is clearly an oversimplification, as many patients have pain for very long periods that is not irreversible infarction but rather ongoing angina. BP 112/80, SpO2 100%. Patient appears only slightly anxious.
She had zero CAD riskfactors. Now you have ECG and troponin evidence of ischemia, AND ventricular dysrhythmia, which means this is NOT a stable ACS. It they are static, then they are not due to ischemia. This is better evidence for ischemia than any other data point. hours of substernal chest pressure.
11 Despite the link between inflammation and cardiovascular disease has been proven by extensive research, most physicians have focused on treating high-risk patients with lipid lowering therapies including statin therapy.1,12,13 mg) to reduce the risks of heart attack, stroke, coronary revascularization, and CV death.29
Typical angina was defined as a symptom complex that includes substernal chest pressure or pain that was made worse with exertion/emotional stress, and relieved by rest or nitroglycerin. Atypical angina is classified as having any two of the three symptoms, and non-anginal pain any one of the three symptoms. years of age versus 59.0±8.4
We evaluated the primary outcome (cardiovascular death, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest) and other end points, by sex, in 1168 (22.6%) women and 4011 (77.4%) men. Guideline‐directed medical therapy use was lower among women with fewer riskfactor goals attained.
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