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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.
The ECLIPSE trial shows that use of IVI to guide coronary stenting in severely calcified lesions prevents death, stent thrombosis, and unplanned repeat procedures in this high-risk patient population. The ECLIPSE trial results were presented at the American College of Cardiology Scientific Session (ACC.25)
No prior exertional complaints of chestpain, dizziness, lightheadedness, or undue shortness of breath. He denied headache or neck pain associated with exertion. I sent this ECG to Dr. Smith, with the only information that it is a 17 year old with chestpain. 24 yo woman with chestpain: Is this STEMI?
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.
Cardiology felt her chestpain to be, most likely, the result of coronary supply-demand mismatch in the context of HCM endothelial remodeling (i.e. Type II MI), however decided to pursue coronaryangiogram out of an abundance of caution. Below are two examples of this. References Naidu, S.
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.
He denied chestpain or dyspnea throughout. Discussion Thus, no further ECGs were recorded and there was no angiogram or stress test or CT coronaryangiogram. Nevertheless, I don't think a thrombosis related type I MI was ruled out here simply because the patient refused further evaluation.
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