The Clinical Problem Solvers Episode 422: WDx #38: Clinical Unknown with UCLA Cardiology fellows
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Oct 2, 2025 Join UCLA Cardiology fellows Dr. Angela Duvalyan and Dr. Rachel Ohman as they dissect a compelling case of a 49-year-old woman with acute chest pain. They navigate through critical differential diagnoses like acute coronary syndrome and the significance of presyncope. The discussion delves into the intriguing findings from the echocardiogram, highlighting hypertrophic cardiomyopathy and its management. The fellows also emphasize the role of cardiac MRI in diagnosing complex cardiac conditions, all while maintaining a focus on patient-centered care.
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Prioritize Can't-Miss Diagnoses
- Acute chest pain in a young woman still mandates prioritizing emergent diagnoses like ACS, dissection, PE, and tamponade.
- The chronic exertional pattern and presyncope broaden the differential to include large-territory coronary disease and non-atherosclerotic MIs.
Start With ECG And Vitals Immediately
- Obtain an immediate ECG and vital signs for any patient with acute chest pain and presyncope.
- Use the history and ECG to rapidly triage for emergent causes while you collect labs and imaging.
Expand ACS To Multiple Phenotypes
- 'ACS' in women includes plaque rupture, SCAD, MINOCA, and embolic MIs, so etiology matters for management.
- Consider non-atherosclerotic causes earlier in younger women without classic risk factors.
