The New England Journal of Medicine
NOVEMBER 29, 2023
A 69-year-old woman with a history of focal pleural plaques due to occupational asbestos exposure presented with chronic dyspnea on exertion. Chest imaging showed calcification of the pericardium.
Dr. Smith's ECG Blog
SEPTEMBER 9, 2024
You can easily imagine this patient getting one of several diagnoses -- vasospasm, MINOCA , pericarditis, or maybe even no diagnosis at all beyond "non-obstructive coronary artery disease." Smith comment : a very high proportion of MINOCA are ruptured plaque with lysed thrombus. That plaque is at risk of thrombosing again.
Dr. Smith's ECG Blog
DECEMBER 10, 2019
Echo does not necessarily differentiate acute MI from pericarditis: both may have wall motion abnormalities. This is why I frequently write: "You diagnose pericarditis at your peril." I have therefore found this sign of limited usefulness in most instances when contemplating a diagnosis of acute pericarditis or myocarditis.
Dr. Paddy Barrett
APRIL 5, 2024
Traditionally used as an anti-inflammatory for pericarditis (inflammation of the lining of the heart), it has recently been shown to result in fewer major heart events in those with a recent heart attack. It is an easy win, frequently missed. Low-dose colchicine of 0.5mg daily resulted in a 23% reduction in future heart events 11.
Dr. Smith's ECG Blog
JANUARY 9, 2023
Only after her troponin peaked at 500,000 ng/L did she get her angiogram, which showed a 100% left main occlusion due to ruptured plaque. Pericarditis? Young people can suffer acute coronary occlusion, whether by typical atherosclerotic plaque rupture, or by coronary anomalies, coronary aneurysms, dissections, spasm, etc.
Dr. Smith's ECG Blog
JANUARY 15, 2024
The "flu-like" illness suggests myo- or pericarditis, but that would be a diagnosis of exclusion. As an aside, the LCx OMI is a type 2 event, since it is due to supply-demand mismatch from thrombus, and not due to atherosclerotic plaque rupture or erosion). Do not wait for the troponin; a lot of myocardium will be dead if you do.
Dr. Smith's ECG Blog
OCTOBER 10, 2022
As in all ischemia interpretations with OMI findings, the findings can be due to type 1 AMI (example: acute coronary plaque rupture and thrombosis) or type 2 AMI (with or without fixed CAD, with severe regional supply/demand mismatch essentially equaling zero blood flow). Submitted by a Med Student, with Great Commentary on Bias!
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