Happy Leap Day!
Vasospasm diagnosis: Can be difficult to diagnose due to the transient nature of these episodes and various groups recommend different things. This algorithm from a review in JACC is helpful in thinking through vasospasm diagnosis.
There is also an international work-group that recommends the following diagnostic criteria
- Nitrate-responsive angina
- Transient ECG changes during episodes of angina
- Angiographic evidence of spasm (and to r/o CAD) – this last one is not totally necessary if you have evidence (1) and (2), but you do need to do a cath anyway to r/o CAD as vasospasm should really be a diagnosis of exclusion. Whether or not to provoke vasospasm during a cath as part of the diagnosis is controversial and discussed in more detail here for those of you that are curious to read more!
Chest pain in a young person
Check out this previous post on our blog for a full differential from Yerem: https://ucsfmed.wordpress.com/2015/08/18/moffitt-cardiology-morning-report-818-chest-pain-in-a-young-person/
ESR vs CRP: Do you need to send both? Or just one? Most people send both (including rheumatologists), but there is some evidence provided by Brad Sharpe that may suggest we don’t need to send both in the hospital medicine setting: http://www.ncbi.nlm.nih.gov/pubmed/20800157