Thread by @mghmedres

1/36 y/o F hx of anxiety p/w a 2nd episode of transient chest pain w emotional stress & her admission EKG shows 4 mm ST elevations in leads V1-V3. Her 1st troponins check was high. She is currently chest-pain free & vitals are normal.

What do you do next?
#MedTwitter

2/ This is a picture of her EKG

3/ You look up and notice the STEMI pathway chart conveniently plastered above your workstation‼️

You recognize the patient's presentation is consistent with ACS and her ST elevations meet criteria for STEMI---> you appropriately escalate and decide to call "code STEMI" 🚨📞

4/ This triggers an expedient pathway that alerts the cardiology team and the cath lab of a possible case. The cards fellow escalates to the interventional team who take the patient to the cath lab!

👀💻You eagerly stalk the chart & see the images are up but not the report 👇

5/ What's the diagnosis? 🤔

6/ The diagnosis is SCAD (Spontaneous Coronary Artery Dissection)! The white arrow shows the 2nd lumen.

This case was presented in today's resident report led by PGY-3 Dr. Nora Abo-Sido and PGY-2 Dr. Shauna Newton!

Here are some #ConferenceTwearls we learned:

7/
💟ACS is a can't miss dx & women can present with "atypical" sx

💟Some serious cardiac conditions can be triggered by emotional stress📢ANXIETY is a dx of exclusion!

💟Have SCAD on the ddx for CP/ACS esp in women!

8/
💟Female sex, FMD, pregnancy, peripartum status are some risk factors for SCAD

💟LAD is the most common artery affected

💟Cor angio is the gold standard for dx but comes w risks like iatrogenic propagation of dissection

Thank you!

#GOREDFORWOMEN
@ddefariayeh
@sarma_amy