Chest pain presentations are common, but management can be variable and difficult to understand. Here is my approach:
Read moreMy approach to chest pain
Severe coronary non-calcified atherosclerosis with severe stenosis, on CT coronary angiography
CT coronary angiography - Cases
Curved reconstruction in CT coronary angiography
A 45-year-old man with no prior cardiac history, but with cardiovascular risk factors including a 10-pack-year smoking history stopped last year, 5-year history of Type II diabetes on Metformin, obesity with BMI of 37, without a family history of premature coronary artery disease, now presented with exertional but inconsistent central chest tightness.
He was investigated extensively, including a negative exercise tolerance ECG at 13 minutes without symptom or ECG change. Despite reassurance, his chest pain continued at random, and has not resolved with a course of Omeprazole for presumed non-cardiac (possibly gastrointestinal reflux) chest pain.
What should we do?
- Reassure him that this pain is almost certainly non-cardiac
- Perform a stress echocardiogram as it has a higher sensitivity than an exercise ECG
- Perform an invasive angiography
Read moreCT coronary angiography - How good is it?
CT coronary angiography - volume rendered image of the left anterior descending artery and its branches
CT coronary angiography has now been routinely performed, at least in the Waitemata area since 2011, where we were the first to implement CTCA in the workup of acute chest pain in New Zealand.
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