Morning report 7/17/2019

Today at morning report we discussed a still evolving case of female patient with chest pain, shortness of breath and food impaction. She was diagnosed with NSTEMI (possibly type II) and possible RA thrombus. A couple of interesting points:

  1. Glucagon is often given for food impaction at the ER although it’s effectiveness if not well demonstrated. Effectiveness of glucagon in relieving esophageal foreign body impaction a multicenter study.
  2. ACS is women can be a lot less clear cut than in men. There is some push to use the term ischemic heart disease (IHD) as opposed to coronary artery disease (CAD) since “Myocardial ischemia has specific sex differences. Despite a lower prevalence of obstructive CAD in women, women have a higher prevalence of symptoms, ischemia, and mortality relative to men.”. This translates clinically in lower yield of traditional testing modalities (myocardial perfusion studies, TTE to look for wall motion abnormalities etc) in women and often less than optimal treatment and increased mortality. Read more on this interesting review Myocardial Ischemia in Women – Lessons from the NHLBI WISE Study





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