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She is the cofounder of FOAMcast and a […] The post SGEM#421: I Think I’d Have a HeartAttack – Maybe Not in a Rural Area? Background: We have covered the issue of heartattacks several times on the SGEM. These include looking at the HEART score, troponin testing and cardiovascular disease in women.
Major adverse cardiac event rates in moderate-risk patients: Does prior coronary disease matter? Major adverse cardiac event rates in moderate-risk patients: Does prior coronary disease matter? Case: You are working a shift in your local community emergency department (ED) when a 47-year-old male presents with chest pain.
He stated it was similar to prior heartattacks. About an hour later, he was then found on the floor in cardiac arrest in the ED. The history in today's case — was that of a man in his 70s who presented to the ED for 2 hours of chest pain , that was still present on arrival in the ED.
Repeat CT angio chest (not CT coronary, unclear what protocol) showed possible LAD aneurysm and thrombus. Finally, coronary angiography was performed (at least 5 days after presentation) which confirmed LAD aneurysm with large thrombus burden, TIMI 0 flow, thrombectomy performed.
He reportedly told his family "I think I'm having a heartattack", then they immediately drove him to the ED, and he was able to ambulate into the triage area before he collapsed and became unresponsive. The value of Stat Echo in the ED for confirming clinical and ECG suspicion of acute PE cannot be overstated!
A 50 something male presented in the evening to ED for evaluation of chest pain that started at 1600. He reports this was similar to how he felt when he had his heartattack 4 years prior, now s/p 4 stents. PMCardio Queen of Hearts AI Model: The Queen of course also thinks it is acute OMI, for the same reasons.
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