Episode 154: Clinical unknown with Dr. Armitage – Headache
Play
https://clinicalproblemsolving.com/wp-content/uploads/2021/01/Clinical-Unknown-Armitage_RTP.mp3

Dr. Dayyan Adoor and Dr. Keith Albrektson present a clinical unknown case to Dr. Armitage

Download CPSolvers App here

Patreon website

Want to test your learning? Take our episode quiz here

Dr. Dayyan Adoor

Dayyan Adoor is a 2nd year internal medicine resident at Case Western Reserve/University Hospitals. Following residency, he hopes to pursue a fellowship in Gastroenterology! In his free time, he likes to spend his time outdoors, often exploring the beautiful parks in Cleveland, and lately, learning how to ski! 

 

Dr. Keith Armitage

Dr. Keith Armitage is a professor of medicine in the division of infectious diseases at the Case Western Reserve University School of medicine. He is also the program director for the internal medicine residency at the Case Western Reserve/University hospitals internal medicine residency program where he is currently serving his 29th year as program director. In his free time Dr Armitage enjoys cheering on his beloved Arsenal Football Club and spending time with his wife and three daughters. 

 

Dr. Keith Albrektson 

Keith Albrektson is a current chief resident at the Case Western Reserve/University hospitals internal medicine residency where he completed his internship and residency in internal medicine. Following his chief year he will be continuing his training in pulmonary and critical care at the University of New Mexico Medical Center.  

Cardionerds: A Cardiology Podcast
Cardionerds: A Cardiology Podcast
CardioNerds
103. Case Report: A Rare Cause of Postpartum Angina and Arrest – University of Maryland
CardioNerds (Amit Goyal & Daniel Ambinder) join University of Maryland cardiology fellows (Manu Mysore, Adam Zviman, and Scott Butler) for some cardiology and an Orioles game in Baltimore! They discuss a rare cause of postpartum angina and cardiac arrest due to coronary vasculitis. Program director Dr. Mukta Srivastava provides the E-CPR expert segment and a message for applicants. Episode notes were developed by Johns Hopkins internal medicine resident Rick Ferraro with mentorship from University of Maryland cardiology fellow Karan Desai. This case has been published in JACC Case Reports! Collect free CME/MOC credit just for enjoying this episode! Jump to: Patient summary - Case media - Case teaching - References Episode graphic by Dr. Carine Hamo Support our educational mission by becoming a Patron!Cardiology Programs Twitter Group created by Dr. Nosheen Reza CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Patient Summary A woman in her early 30s with a past medical history of Hashimoto's thyroiditis and one prior miscarriage at <8 weeks presented with chest pain about 6 weeks postpartum from the birth of her third child. In the ED, she continued to report intermittent sharp chest discomfort and found to have a diastolic decrescendo murmur at the left upper sternal border and labs demonstrating a troponin-I of 0.07 ng/dL. Join the UMD Cardionerds for the incredible course and story of this young patient as we go through the differentia and approach to postpartum chest pain and ultimately arrive in a very rare diagnosis!   For a detailed course, enjoy the JACC case report. Case Media Visit the JACC Case Reports to review the case media! Episode Schematics & Teaching The CardioNerds 5! – 5 major takeaways from the #CNCR case 1. How Do We Evaluate Chest Pain in Younger Patients  Start with the same things as everyone else!  Think broadly about the big three concerning etiologies of chest pain: Cardiac, Gastric, and Pulmonary (The excellent Clinical Problems Solvers 4+2+2 construct here is always a great resource. Find them at: https://clinicalproblemsolving.com/dx-schema-chest-pain/).   Of course it is important to think about non-life threatening etiologies as well – esophageal spasm, gastric ulcer, rib fracture, skin lesion, among many others - given that high-risk chest pain is less likely in younger adults.  While less common, acute coronary syndrome is not uncommon in young patients, as 23% of patients with MI present at age <55 years.   2. What About Chest Pain in Women?   As has been discussed on the Cardionerds podcast (Listen to episodes with Dr. Nanette Wenger, Dr Martha Gulati, and Dr. Leslie Cho), women generally present with acute coronary syndrome at a later age, with a higher burden of risk factors than men, and with greater symptom burden but are less likely to be treated with guideline-directed medical therapies, undergo cardiac catheterization and receive timely reperfusion. In one study of young patients with acute MI, women – 19% of cases overall – were less likely to undergo revascularization or receive guideline-directed therapy The construct of classifying chest pain as "typical" and "atypical" likely leads to misdiagnosis or delayed diagnosis of acute myocardial infarction in women. Rather, it is important to recognize that while symptoms may not be "typical" for angina, coronary disease can manifest in many different ways.  While many women will presents with chest pain suggestive of angina, women are more likely than men to present with dyspnea, indigestion, weakness, nausea/vomiting and/or fatigue. Note, shoulder pain and arm pain are twice as predictive of an acute myocardial infarction diagnosis in women compared with men.  Furthermore,
52 min
More episodes
Search
Clear search
Close search
Google apps
Main menu