2014 ACS Coronary 
Dr. Smith's ECG Blog
APRIL 18, 2024
The ECG is just a test: a Bayesian approach to acute coronary occlusion If a patient with a recent femur fracture has sudden onset of pleuritic chest pain, shortness of breath, and hemoptysis, the D-dimer doesn’t matter: the patient’s pre-test likelihood for PE is so high that they need a CT. Circulation 2014 2. But does this matter?
Dr. Smith's ECG Blog
DECEMBER 27, 2023
Note that as many as 7% of patients with acute coronary syndrome have chest pain reproducible on palpation [Lee, Solomon]. which reduces the pre-test probability of acute coronary syndrome by less than 30% [McGee]. The note also says "slight lateral ST elevations noted, likely early repolarization since unchanged compared to 2014."
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Dr. Smith's ECG Blog
NOVEMBER 4, 2022
Smith: If this is ACS (a big if), t his is just the time when one should NOT use "upstream" dual anti-platelet therapy ("upstream" means in the ED before angiography). History sounds concerning for ACS (could be critical stenosis, triple vessel), but differential also includes dissection, GI bleed, etc. Anything more on history?
Dr. Smith's ECG Blog
DECEMBER 14, 2016
We could not rule out acute epicardial coronary (large artery) occlusion. Learning Point Acute coronary occlusion may occur with no ECG findings whatsoever. This is from the 2014 ACC/AHA guidelines. Patients with ACS and hemodynamic instability 2. Patients with ACS and acute pulmonary edema 3. This includes: 1.
Dr. Smith's ECG Blog
NOVEMBER 19, 2016
The diagnostic coronary angiogram identified only minimal coronary artery disease, but there was a severely calcified, ‘immobile’ aortic valve. Author continued : STE in aVR is often due to left main coronary artery obstruction (OR 4.72), and is associated with in-hospital cardiovascular mortality (OR 5.58).
EM Didactic
OCTOBER 7, 2018
Other possible reasons for higher levels could be: Pregnancy Coronary Artery Disease Viral Infections (10–40 mg/L) Bacterial infection (>40mg/dL) Malignancy, Obstructive Sleep Apnea, Connective Tissue Disorders Serial CRP measurements may be helpful to monitor a patient’s response to medical intervention. 2014 Jan 1;3(1):1-5.
Dr. Smith's ECG Blog
JULY 3, 2018
The AHA/ACC guidelines recommend emergent cardiac catheterization for patients with concern for ACS and refractory chest pain despite maximum medical therapy defined as aspirin + clopidogrel/ticagrelor + heparin/enoxaparin. link] He was admitted to the cardiology unit for serial troponin measurements and concern for possible ACS.
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