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A coronary angiogram, that tends to cross the boundaries of your thoughts

Dr. S. Venkatesan MD

Wuhan Asia Heart Hospital, Wuhan, China Did you guess the diagnosis correctly? It is an acceptable diagnosis, if you thought an anomalous LCA, a LAD CTO or a single coronary artery. Video source and courtesy: Leizhi Ku,, Xiaojing Ma, From the Departments of Radiology (L.K.) and Echocardiography (X.M.), It is left main atresia.

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An undergraduate who is an EKG tech sees something. The computer calls it completely normal. How about the physicians?

Dr. Smith's ECG Blog

So the patient was admitted to the hospital with no plan for an angiogram. The Queen of Hearts now sees no OMI with low confidence: The patient did not receive an angiogram on day two of his hospitalization because the cath lab was too busy. Instead he had an angiogram at 0800 on day 3. Smith: What???!!!

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63 year old with "good story for ACS" but negative troponins.

Dr. Smith's ECG Blog

This was texted to me from a former resident, while working at a small rural hospital, with the statement: "I can’t convince myself of anything here, but he’s a 63-year-old guy with prior stents and a good story for ACS." We don't know if he had a stress test, a CT Coronary angiogram, or they just decided to do an angiogram.

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Distractions

EMS 12-Lead

He denied any known medical history, specifically: coronary artery disease, hypertension, dyslipidemia, diabetes, heart failure, myocardial infarction, or any prior PCI/stent. Learning points 1] Acute Coronary Syndrome has many shades of clinical manifestation. No appreciable skin pallor. Here is the time-zero 12 Lead ECG.

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Hypertrophic Cardiomyopathy

EMS 12-Lead

This worried the crew of potential acute coronary syndrome and STEMI was activated pre-hospital. When OMI is captured in this early phase, there exists the highest amount of salvageable myocardium and least likelihood of heart failure at hospital discharge. A mid-LAD culprit lesion was identified and stented.

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Rise of the Lysenkoist Cardiologists

Dr. Anish Koka

Diamond and Forrester accomplished this by first establishing the prevalence of coronary artery disease based on how clinically likely patients with chest pain symptoms were found to have coronary disease based on a coronary angiogram. and 1.7% [ P =0.43]; 12‐month: 0.6% Which is exactly what the numbers show.