All data suggest unstable angina, but the angiogram is normal. Ken Grauer on stress testing.

A 50-something woman who has a gastric ulcer was experiencing epigastric pain for which she decided to come to the ED.  Then, approxiately one hour prior to arrival, she experienced some chest discomfort which was sharp, central, 10/10, with SOB, diaphoresis, dizziness, and nausea.  Since that time it has been intermittent.  She called 911 and still had pain when the medics arrived, but it resolved with sublingual NTG x 2.  On arrival she was chest pain free, but still had the epigastric pain.Prehospital vitals:We could not find the prehospital EKG.Here is the first ED ECG, recorded while asymptomatic:There is what appears to be ischemic ST depression in II, III, aVF, and V5, V6.  There is no other good explanation for it.She did have a previous ECG available:This confirms that the ST depression is new.  The precordial T-waves were more robust on the previous than they are on the present ECG.The first high sensitivity troponin I returned at ＜ 4 ng/L (below the LoD, which all but rules out acute MI)During her ED stay, one hour later, she had recurrent chest pain and another ECG was recorded.Strangely, the ST depression is GONE during pain and it was present while she was asymptomatic.I was worried about the ST depression on the first ECG, and then even more worried when I saw that it was dynamic.The 2nd high sens trop returned at ＜ 4 ng/L, still below the LoD.  Thus, there is no acute MI.But I know thatunstable angina still exis...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs