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Circulation: Cardiovascular Interventions, Ahead of Print. The primary endpoint was the incidence of device syndrome, a composite of patient-reported symptoms (chestpain, palpitations, migraines, dyspnea, and rash).Results:Of However, the impact of nickel hypersensitivity on post-procedural outcomes remains poorly understood.
Written by Jesse McLaren A previously healthy 50 year-old presented with 24 hours of intermittent exertional chestpain, radiating to the arms and associated with shortness of breath. In a previously healthy patient with new and ongoing chestpain, this is concerning for acute occlusion of the first diagonal artery.
He presented to the ED 1 day later: He stated that he had continued episodes of chestpain and then it became constant that morning (about 8 hours prior). There is no change in symptoms with exertion, the pain is not pleuritic, positional, or reproducible by palpation. Never assume chestpain is reflux.
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.
Circulation, Volume 150, Issue Suppl_1 , Page A4136277-A4136277, November 12, 2024. Introduction:The most common acute coronary syndrome (ACS) symptom is chestpain. Chestpain is an umbrella term more precisely described using words like pressure or tightness. Methods:Participants from across the U.S.
Sent by anonymous, written by Pendell Meyers A man in his 50s with no prior known medical history presented to the Emergency Department with severe intermittent chestpain. He denied any lightheadedness, shortness of breath, vomiting, or abdominal pain. Circulation. Isn't it amazing?? 2001;104:636–641.
Submitted and written by Megan Lieb, DO with edits by Bracey, Smith, Meyers, and Grauer A 50-ish year old man with ICD presented to the emergency department with substernal chestpain for 3 hours prior to arrival. At this time he reported ongoing chestpain and was given aspirin and nitroglycerin.
A middle aged male presented at midnight after 14 hours of constant, severe substernal chestpain, radiating to his throat and to bilateral jaws, and associated with diaphoresis. The pain was not positional, pleuritic, or reproducible. It was not relieved by anything. He had no previous medical history.
Of course this depends on many factors: 1) duration of occlusion, 2) whether full or near occlusion with zero flow or some flow -- the flow in the artery is the critical factor, measured by "TIMI" flow, 3) presence of collateral circulation and others. Upon questioning patient, he denies having any chestpain or chest tightness of any sort.
A 70-year-old man calls 911 after experiencing sudden, severe chestpain. Circulation. Does routine use of the 15-lead ECG improve the diagnosis of acute myocardial infarction in patients with chestpain? This case comes from Sam Ghali ( @EM_RESUS ). Thanks, Sam! This is his 12-Lead ECG: What do you think?
Circulation: Cardiovascular Imaging, Volume 16, Issue 11 , Page e015800, November 1, 2023. 1.39];P=0.669) did not differ significantly between groups.CONCLUSIONS:In patients with stable chestpain referred for ICA, CCTA avoided the need for ICA in 77% of patients otherwise referred for ICA. were referred to CCTA and 22.5%
Because the patient had no chestpain or shortness of breath, they were initially diagnosed as gastroenteritis. But because the patient had no chestpain or shortness of breath, it was not deemed to be from ACS. But because the patient had no chestpain or shortness of breath, it was not deemed to be from ACS.
Circulation, Volume 150, Issue Suppl_1 , Page A4137144-A4137144, November 12, 2024. The patient’s chestpain (CP) was not alleviated with initial revascularization of his left circumflex (LCx) ST, requiring PCI to his right coronary artery (RCA) chronic total occlusion (CTO). We present a case of reinfarction from ST.
Circulation: Genomic and Precision Medicine, Volume 16, Issue 5 , Page 442-451, October 1, 2023. Background:Patients with de novo chestpain, referred for evaluation of possible coronary artery disease (CAD), frequently have an absence of CAD resulting in millions of tests not having any clinical impact.
Written by Willy Frick A man in his 50s with a history of hypertension, dyslipidemia, type 2 diabetes mellitus, and prior inferior OMI status post DES to his proximal RCA 3 years prior presented to the emergency department at around 3 AM complaining of chestpain onset around 9 PM the evening prior. The following ECG was obtained.
Angiography usually reveals an absence of collateral circulation to the infarct zone. But in the other half of this 30% ( ie, in ~15% of all patients with MI ) — although these patients found on follow-up ECG to have had infarction did not have chestpain — they did have "something else" thought to be associated with their MI.
2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of ChestPain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. Gulati M, Levy PD, Mukherjee D, et al. 2021 Nov 30;144(22):e368-e454.
Written by Jesse McLaren A 70 year old with prior MIs and stents to LAD and RCA presented to the emergency department with 2 weeks of increasing exertional chestpain radiating to the left arm, associated with nausea. Circulation 2014 2. Echo showed new anterior regional wall motion abnormality and decrease EF from 60% to 45%.
Jesse McLaren (@ECGcases), of Emergency Medicine Cases Reviewed by Pendell Meyers and Steve Smith An 85yo with a history of hypertension developed chestpain and collapsed, and had bystander CPR. On arrival, GCS was 13 and the patient complained of ongoing chestpain. Vitals were HR 58 BP 167/70 R20 sat 96%.
Marcus, G. Harvard Medical School, Boston, Massachusetts, USA. Metoprolol and atenolol are overwhelmingly beta-1 cardioselective. Beta-1 blockade decreases inotropy and chronotropy and has no vasoconstrictive effects. Only beta-2 blockade (e.g., Philippides, G. Henry Ford Hospital. Philippides, G. Henry Ford Hospital.
A middle aged male presented with chestpain. In LVH, T-wave inversions are usually much more assymetric , like these (Figure 2): Acute Chestpain, but baseline ECG. And sometimes the lateral T-wave is biphasic, with the terminal portion more upright (Figure 3): Acute chestpain. Baseline EKG, no MI.
But, in a patient who presents to the ED for new chestpain — seeing these subtle findings that are localized to leads V2- thru -V4 should at the least make you consider acute posterior OMI ( O cclusion-based MI ) — until you prove otherwise. To EMPHASIZE: These are subtle findings. What do YOU think?
The history is concerning ( This patient was awakened from sleep by chestpain that persisted for several hours — on a background of intermittent CP in recent weeks ). The ECG changes seen between the initial ECG and the repeat ECG after NTG — are undeniable! Nor was there a challenge to look for coronary spasm.
Circulation, Volume 150, Issue Suppl_1 , Page A4119267-A4119267, November 12, 2024. Advanced cardiac imaging especially in atypical presentations, can aid in early diagnosis.Case:A 59 year-old man with history of biopsy-proven pulmonary sarcoidosis presented with non exertional chestpain for 2 months.
Circulation: Arrhythmia and Electrophysiology, Ahead of Print. Postablation chestpain consistent with pericarditis was reduced with colchicine (4% versus 15%; HR, 0.26 [95% CI, 0.09–0.77];P=0.02) BACKGROUND:Inflammation may promote atrial fibrillation (AF) recurrence after catheter ablation. 2.02];P=0.89). 1.99];P=0.55).CONCLUSIONS:Colchicine
This male in his 40's had been having intermittent chestpain for one week. He awoke from sleep with crushing central chestpain and called ems. EMS recorded a 12-lead, then gave 2 sublingual nitros with complete relief of pain. Type B waves are deeper and symmetric.
a med tech company dedicated to helping patients with persistent ischemic heart disease, has announced the treatment of the first patient with the A-FLUX Reducer System, a treatment for patients with angina or chestpain. Circulation. VahatiCor, Inc., Angina is often caused by reduced blood flow to the heart. 27 May 2021.
This 42 yo diabetic male presented with cough and foot pain. In spite of aggressive questioning, he denied chestpain, but he did tell one triage nurse that he had had some chest burning, and so he underwent an ECG: There are deep Q-waves and QS-waves in precordial leads V2-V3, with a bit of R-wave left in V4.
He had no previous history of CAD, and presented with very typical waxing and waning chestpain, much worse with exertion but also present at rest and on presentation, though his pain was minimal at the time of the ECG. I saw this 59 year old male 3 weeks ago. Blood pressure was 150/80. The ECG normalized overnight.
Circulation, Volume 150, Issue Suppl_1 , Page A4139995-A4139995, November 12, 2024. VSA) was defined as significant angiographic vasospasm accompanied by chestpain and/or ischemic electrocardiographic changes.Results:Of the 723 patients included in this study, 383 (53.0%) had positive ACh provocation tests.
Later, I found old ECGs: 5 month prior in clinic: V5 and V6 look like OMI 9 months prior in clinic with no chest symptoms: V5 and V6 look like OMI 1 year prior in the ED with chestpain: V5 and V6 sure look like a STEMI For this ECG and chestpain in the ED, the Cath lab activated. But the angiogram was clean.
As discussed in detail in ECG Blog #228 — this seemingly qualifies as a “ Silent ” MI ( Approximately half of those MIs not accompanied by CP — have some other associated symptom such as syncope, which substitutes as a “chestpain equivalent” ).
Circulation: Arrhythmia and Electrophysiology, Ahead of Print. BACKGROUND:There is no specific treatment for sudden cardiac arrest (SCA) manifesting as pulseless electric activity (PEA) and survival rates are low; unlike ventricular fibrillation (VF), which is treatable by defibrillation.
However ,we have some effective clinical and pathological markers too, for effective re-vascularisation They are clinical well being and good functional capacity , relief from chest-pain, reduction of plaque volume, plaque stabilisation, maintenance of collaterals , microvascular patency , reduction of recurrent events.
Circulation, Volume 150, Issue Suppl_1 , Page A4145631-A4145631, November 12, 2024. Urgent angiography revealed complete occlusion with thrombus of the proximal left anterior descending (LAD) coronary artery. The patient underwent aspiration thrombectomy, followed by intracoronary vasodilators, without improvement of flow.
Circulation, Volume 150, Issue Suppl_1 , Page A4145414-A4145414, November 12, 2024. Subsequently, he developed chestpain with hypotension, diffuse ST elevations on ECG, and hsTropI of 638 ng/L. Labs include WBC count 13320/cmm with 85% neutrophils, total bilirubin 13.1 mg/dL, direct bilirubin 9.3
Circulation, Volume 150, Issue Suppl_1 , Page A4135360-A4135360, November 12, 2024. Case presentation:A 64-year-old man presented with one day of chestpain. Initial evaluation showed elevated cardiac enzymes (CE) and normal eosinophil count. Electrocardiogram (EKG) was unremarkable.
Circulation, Volume 150, Issue Suppl_1 , Page A4119169-A4119169, November 12, 2024. PCI has become a common treatment of chronic total occlusion, and techniques continue to be developed to tackle more challenging cases. Her EKG showed marked left-axis deviation, ST depressions in V2-V4, and RBBB.
Circulation, Volume 150, Issue Suppl_1 , Page A4115231-A4115231, November 12, 2024. Data were derived from the American College of Cardiology ChestPain – MI Registry data collected by trained abstractors at the facility and were verifed by the study team.
This was a male in his 50's with a history of hypertension and possible diabetes mellitus who presented to the emergency department with a history of squeezing chestpain, lasting 5 minutes at a time, with several episodes over the past couple of months. Plan was for admission for chestpain workup. Jernberg T, et al.
A middle aged male with no h/o CAD presented with one week of crescendo exertional angina, and had chestpain 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.
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