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Three normal high sensitivity troponins over 4 hours with a "normal ECG"

Dr. Smith's ECG Blog

Thus, the patient does not (yet) get a formal diagnosis of MI and must be called unstable angina unless further troponins return above the 99th percentile. On the basis of unresolved angina, cardiology decided to perform rescue PCI. Medically refractory angina should have immediate angiography, but this only happens 6.4%

Angina 120
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Dynamic OMI ECG. Negative trops and negative angiogram does not rule out coronary ischemia or ACS.

Dr. Smith's ECG Blog

Bedside cardiac ultrasound with no obvious wall motion abnormalities. He had a previous ECG on file: Proving the findings are new The cath lab was activated. He was given aspirin and sublingual nitro and the pain resolved. He was started on nitro gtt. BP initially 160s/90s, O2 sats 95% on room air.

Ischemia 121
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Chest pain, resolved. Does it need emergent cath lab activation (some controversy here)? And much much more.

Dr. Smith's ECG Blog

Bedside ultrasound with no apparent wall motion abnormalities, no pericardial effusion, no right heart strain. Patient is pain free and clearly has Wellens' syndrome: 1) pain free episode following an episode of angina, typical Pattern A (biphasic, terminal T-wave inversion with an initial upsloping ST Segment) findings, preserved R-waves.

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Concerning EKG with a Non-obstructive angiogram. What happened?

Dr. Smith's ECG Blog

The commonest causes of MINOCA include: atherosclerotic causes such as plaque rupture or erosion with spontaneous thrombolysis, and non-atherosclerotic causes such as coronary vasospasm (sometimes called variant angina or Prinzmetal's angina), coronary embolism or thrombosis, possibly microvascular dysfunction.

Plaque 127
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Acute chest pain in a young man with low cardiovascular risk profile

Heart BMJ

There was no antecedent angina. Intravascular ultrasound was also performed ( figure 1B ). Clinical introduction Vignette A man in his 40s presented to our emergency department with sudden onset of severe central chest pain radiating to his left arm. He was sweaty, clammy and had accompanying breathlessness. fig loc="float".

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Optimal Predilatation Treatment Before Implantation of a Magmaris Bioresorbable Scaffold in Coronary Artery Stenosis: The OPTIMIS Trial

Circulation: Cardiovascular Interventions

Six-month angiographic follow-up with optical coherence tomography and intravascular ultrasound was available in 74 patients. Intravascular ultrasound findings showed no difference in mean vessel area at the lesion site from baseline to follow-up in the scoring balloon group (16.82.9 versus 6.31.5 mm2;P=0.65), mean scaffold area (7.81.5

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N-terminal pro–B-type natriuretic peptide and pulmonary echography are predictors of acute heart failure needing early mechanical ventilation in acute coronary syndrome

Coronary Artery Disease Journal

A pulmonary ultrasound was performed on admission and was considered positive (PE+) when there were three or more B-lines in two quadrants or more of each hemithorax. Conclusion Lung ultrasound and a high NT-proBNP (3647 ng/L in our series) on admission are the best predictors of acute heart failure needing MV in the first 48 h of ACS.