Intermittent increasing exertional chest pain and serial negative troponins
I was shown this ECG at triage, recorded on a patient with a chief complaint of chest pain, where I was working: What do you think? My…
Dynamic, Reversible, Ischemic T-wave inversion mimics Wellens’. All trops negative.
A middle-aged man presented with 7-8/10 non-radiating chest tightness to the left chest wall, associated with nausea but no diaphoresis, that…
Our residents are getting really good at this.
I was asked to look at this ECG in a patient with 30 minutes of acute onset of nausea and vomiting and perhaps some chest discomfort: First ED…
Is this a STEMI? No, not by definition! Why not? Why is this Important?
A 40-something male presented with dyspnea and left arm numbness, and perhaps some chest tightness, for 1 1/2 hours. Here is his triage ECG:…
“Unstable Angina still exists”, even in the Age of High Sensitivity Troponin
This case comes from a long term blog reader from Norway. Case: 49 y.o male. No previous medical hx. 15-20 pack year smoking history.…
Test yourself: how many hours between your diagnosis of OMI and positive STEMI criteria?
Written by Pendell Meyers, with edits by Steve Smith A male in his early 40s presented with intermittent chest/abdominal pain. He admitted to…
It is Far too Early for a Requiem for Unstable Angina
Dr. Braunwald declared that high sensitivity troponins will make Unstable Angina a thing of the past. That very well may be true, but in…
Dynamic T-wave inversion (apparent Wellens’ waves), all troponins negative: Unstable Angina
This middle-aged woman presented with increasing intermittent substernal chest discomfort similar to her GERD, but not relieved by the usual…
Unstable Angina: Dr. Braunwald asks if it is time for a Requiem
In a recent commentary, Dr. Eugene Braunwald asked if it is time for a Requiem for Unstable Angina (ACS without a positive troponin, as…
A Very Unstable Angina. No STEMI present, but needs the cath lab now.
An elderly woman with h/o diabetes and hypertension but no prior cardiac history had been having exertional chest pain for months, though with…