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So... I saw the following patient the other day. My attending and I disagreed on the management/disposition.
28 yo F was sent in from the PMD office for intermitent CP and HA x 3 wks. HA was mild and constant, but relieved with tylenol prn. Kind of a poor historian. Pt said CP was getting progressively worse over last 3 weeks, not exertionally related, and today lasted 8 hours so she went to her PMD office and had an EKG done. It was NSR w/ TWI in the inferior leads & V1-V3 with TW flattening in V4/V5. She was then sent to the ER for an evaluation. Our repeat EKG showed the same thing. There was no old EKG, and she had never had a stress test.
In the room she was non-toxic, vitals stable, CP was somewhat reproducible with movement & palpation. She denied any risk factors for CAD or PE/DVT, and no family hx of early CAD.
Her work-up was totally normal including CXR, basic labs, cardiac enzymes, CT Brain. What would you do with her?
28 yo F was sent in from the PMD office for intermitent CP and HA x 3 wks. HA was mild and constant, but relieved with tylenol prn. Kind of a poor historian. Pt said CP was getting progressively worse over last 3 weeks, not exertionally related, and today lasted 8 hours so she went to her PMD office and had an EKG done. It was NSR w/ TWI in the inferior leads & V1-V3 with TW flattening in V4/V5. She was then sent to the ER for an evaluation. Our repeat EKG showed the same thing. There was no old EKG, and she had never had a stress test.
In the room she was non-toxic, vitals stable, CP was somewhat reproducible with movement & palpation. She denied any risk factors for CAD or PE/DVT, and no family hx of early CAD.
Her work-up was totally normal including CXR, basic labs, cardiac enzymes, CT Brain. What would you do with her?