A 32 yrs male,smoker came to me with c/ochest pain retrosternal early in the morning,squeezing,pointing at precordial area near xephisternum intermittent and some times burning and pricking,it is unusal feeling for him. Ecg done twice but cardiologists are confused,Plz discuss

Late 30s y/o male meth user, admitted for AKI and rash, develops acute CP, diaphoresis, bradycardia, SOB and the following ECG. Cardiac #Catheterization is 100% normal. LV gram normal. Vitals stable. Pain unremitting with morphine. What's the DDx??!

FOR INFORMATION ONLY: 55yr male, diabetic, presented at OPD with history of pain chest on exertion for last 3 months. ECG : INF. Wall MI ? duration TMT : was not done because of above ECG findings echo: WNL, no RWMA trop-T - negative CAG: coronaries found to be normal. ECG & angio pictures are posted

29yo/m presents to the ED with chest discomfort. He describes his pain as dull non radiating behind the sternum. He states his pain began while he was walking around at work and is unrelieved by rest. Pain is non positional. Patient denies any prior cardiac Hx and has never experienced this discomfort before. He presents A/Ox4 with skin P/W/D. Denies N&V or SOB. Lung sounds clear and equal. Vitals all within normal limits. Patients pain is relieved after one sublingual nitro. Initial POC troponin is 0.18. Patient sent to catch lab. Thoughts?

*Angina* ☝ *All about*☝ is chest pain, discomfort, or tightness that occurs when an area of the heart muscle receives decreased blood oxygen supply. It is not a disease itself, but rather a likely symptom of coronary artery disease, the most common type of heart disease. The lack of oxygen-rich blood to the heart is usually a result of narrower coronary arteries due to plaque build-up; a condition called atherosclerosis. History The condition was named “hritshoola” in ancient India and was described by Sushruta (6th century BC). Types Stable (or chronic) angina Stable angina occurs when the heart is working harder than usual, for instance, during exercise. It has a regular pattern and can be predicted to happen over months or even years. Rest or medication relieves symptoms. Unstable angina Unstable angina does not follow a regular pattern. It can occur when at rest and is considered less common and more serious because rest and medication does not relieve it. This version can signal a future heart attack within a short time – hours or weeks. Variant and microvascular angina Variant (Prinzmetal’s) angina and microvascular (smallest vessels) angina are rare and can occur at rest without any underlying coronary artery disease. This angina is usually due to abnormal narrowing or relaxation (spasm) of the blood vessels, reducing blood flow to the heart. It is relieved by medicine. Risk factors The following risk factors increase your risk of coronary artery disease and angina: Tobacco use. Chewing tobacco, smoking and long-term exposure to second-hand smoke damage the interior walls of arteries including arteries to your heart allowing deposits of cholesterol to collect and block blood flow. Diabetes. Diabetes is the inability of your body to produce enough insulin or respond to insulin properly. Insulin, a hormone secreted by your pancreas, allows your body to use glucose, which is a form of sugar from foods. Diabetes increases the risk of coronary artery disease, which leads to angina and heart attacks by speeding up atherosclerosis. High blood pressure. Blood pressure is determined by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. Over time, high blood pressure damages arteries. High blood cholesterol or triglyceride levels. Cholesterol is a major part of the deposits that can narrow arteries throughout your body, including those that supply your heart. A high level of the wrong kind of cholesterol, known as low-density lipoprotein (LDL) cholesterol (the “bad” cholesterol), increases your risk of angina and heart attacks. A high level of triglycerides, a type of blood fat related to your diet, also is undesirable. History of heart disease. If you have coronary artery disease or if you’ve had a heart attack, you’re at a greater risk of developing angina. Older age. Men older than 45 and women older than 55 have a greater risk than do younger adults. Lack of exercise. An inactive lifestyle contributes to high cholesterol, high blood pressure, type 2 diabetes and obesity. However, it is important to talk with your doctor before starting an exercise program. Obesity. Obesity raises the risk of angina and heart disease because it’s associated with high blood cholesterol levels, high blood pressure and diabetes. Also, your heart has to work harder to supply blood to the excess tissue. Stress. Stress can increase your risk of angina and heart attacks. Too much stress, as well as anger, can also raise your blood pressure. Surges of hormones produced during stress can narrow your arteries and worsen angina. Causes Angina is usually caused by coronary heart disease. When the arteries that supply your heart muscle with blood and oxygen become narrowed, the blood supply to your heart muscle is restricted. This can cause the symptoms of angina. Angina symptoms are often brought on by physical activity, an emotional upset, cold weather or after a meal. The episodes usually subside after a few minutes. Symptoms Symptoms associated with angina include: Chest pain or discomfort Pain in your arms, neck, jaw, shoulder or back accompanying chest pain Nausea Fatigue Shortness of breath Sweating Dizziness The chest pain and discomfort common with angina may be described as pressure, squeezing, fullness or pain in the center of your chest. Some people with angina symptoms describe angina as feeling like a vise is squeezing their chest or feeling like a heavy weight has been placed on their chest. For others, it may feel like indigestion. Diagnosis and test A correct diagnosis for chest pain is important because it can predict the likelihood of having a heart attack. The process will start with a physical exam as well as a discussion of symptoms, risk factors, and family medical history. A physician who is suspicious of angina will order one or more of the following tests: Electrocardiogram (EKG) – records electrical activity of the heart and can detect when the heart is starved of oxygen. Stress test – blood pressure readings and an EKG while the patient is increasing physical activity. Chest X-ray – to see structures inside the chest. Coronary angiography – dye and special X-rays to show the inside of coronary arteries (dye is inserted using cardiac catheterization). Blood tests – to check levels of fats, cholesterol, sugar, and proteins. Treatment and medications Angina treatments aim to reduce pain, prevent symptoms, and prevent or lower the risk of heart attack. Medicines, lifestyle changes, and medical procedures may all be employed. Lifestyle changes recommended to treat angina include: stopping smoking controlling weight regularly checking cholesterol levels resting and slowing down avoiding large meals learning how to handle or avoid stress eating fruits, vegetables, whole grains, low-fat or no-fat dairy products, and lean meat and fish Medicines called nitrates (like nitroglycerin) are most often prescribed for angina. Nitrates prevent or reduce the intensity of angina attacks by relaxing and widening blood vessels. Other medicines may be used such as: Beta blockers Calcium channel blockers ACE (angiotensin-covering enzyme) inhibitors Oral anti-platelet medicines Anticoagulants High blood pressure medications may also be prescribed to treat angina. These medicines are designed to lower blood pressure and cholesterol levels, slow the heart rate, relax blood vessels, reduce strain on the heart, and prevent blood clots from forming. In some cases, surgical medical procedures are necessary to treat angina. A heart specialist may recommend angioplasty. Coronary artery bypass grafting is another standard procedure; this is surgery where the narrowed arteries in the heart are bypassed using a healthy artery or vein from another part of the body. Prevention Unfortunately you can’t reverse coronary heart disease, which causes angina, but you can delay your arteries narrowing. To do this it’s important to: Stop smoking Control high blood pressure Reduce your cholesterol level Be physically active Achieve and maintain a healthy weight Control your blood glucose if you have diabetes Eat a healthy, balanced dietand only drink moderate amounts of alcohol. Some medications can also be used to help prevent angina episodes