The Curbsiders Internal Medicine Podcast #450 Acute Coronary Syndrome with Dr. Sanjeev Francis - Part 1
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Aug 26, 2024 
Dr. Sanjeev Francis, a cardiologist at Maine Medical Center, dives deep into acute coronary syndrome. He discusses the vital role of comprehensive patient assessment, emphasizing unique presentations in women. The conversation highlights advancements in high-sensitivity troponin tests, their implications for diagnosis, and the importance of serial ECGs in atypical cases. With insights on risk stratification tools and non-invasive testing options, this insightful dialogue not only educates but also entertains with personal anecdotes and critical case studies.
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Differential Diagnosis for Chest Pain
- Consider aortic syndromes and pulmonary embolisms (PE) in patients with acute chest pain.
- Ask qualifying questions about pain severity, tearing sensation, and PE risk factors to differentiate.
Risk Factors for ACS
Classic acute coronary syndrome (ACS) risk factors include hypertension, hyperlipidemia, diabetes, and family history.
- Smoking is the biggest risk factor for coronary and vascular disease.
Physical Exam for ACS
- Assess general appearance, vital signs, and JVP for heart failure.
- Auscultate carotids for bruits, a marker of atherosclerosis.