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The patient was brought directly to the cardiac catheterization lab for PCI, bypassing the ED. The diagnostic coronaryangiogram identified only minimal coronaryartery disease, but there was a severely calcified, ‘immobile’ aortic valve. Aortic angiogram did not reveal aortic dissection.
The patient was started on heparin for possible NSTEMI vs demand ischemia. increasing stenosis, ischemia, volume changes, increased blood pressure, atrial fibrillation, etc.) The EKGs from the ED presentation were felt by cardiology to represent "subendocardial ischemia." Smith : these ECGs do NOT show subendocardial ischemia.
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Coronary Angiogram 
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