Chest Pain: Coronary CT Angiography in the ED

It is well known that taking a good history and physical, getting a non-ischemic EKG, and serial cardiac biomarkers, results in a risk of death/AMI of <5% in 30 days. Patients, in whom you still suspect have CAD, should undergo provocative testing within the next 72 hours based on the AHA/ACC guidelines. Their guidelines deem provocative testing as including:

Exercise treadmill stress test,
Myocardial perfusion scan,
Stress echocardiography, and/or
Coronary CT angiography (CCTA).

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By Salim Rezaie, MD|2019-09-10T13:38:05-07:00Apr 11, 2013|Cardiovascular, Radiology|

Hospital admissions for chest pain often incur costly and resource-intensive workups for ACS. Is there a way to identify a low risk group who can be discharged home in a timely manner, without further workup, and without short-term adverse events from ACS?

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By Salim Rezaie, MD|2019-09-10T13:37:46-07:00Apr 4, 2013|Cardiovascular|

With Dr. Jeff Tabas giving a lecture on the perennially hot topic of pulmonary embolism (PE) at the upcoming UCSF High Risk EM Conference (main link, PDF Brochure) in San Francisco May 22-24, 2013, I thought I would get a sneak peek into his discussion points.

Rivaroxaban for Pulmonary Embolism: One pill and done?
By Prathap Sooriyakumaran, MD and Jeffrey Tabas, MD
UCSF-SFGH Emergency Medicine (more…)

By Michelle Lin, MD|2018-08-23T19:16:55-07:00Apr 3, 2013|Cardiovascular, Pulmonary, Tox & Medications|

Chest Pain: What is the Value of a Good History?

Every year there are 6 million visits to the Emergency Department (ED) for chest pain, and approximately 2 million hospital admissions each year.¹ This is approximately about 10% of ED visits and 25% of hospital admissions with 85% of these admissions receiving a diagnosis of a non-ischemic etiology to their chest pain (CP).² This over triage has enormous economic implications for the US health care system estimated at $8 billion in annual costs.

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By Salim Rezaie, MD|2019-09-10T13:37:37-07:00Mar 28, 2013|Cardiovascular|

Lytics for sub-massive PE: Ready for primetime?

There was recently a great study published in the American Journal of Cardiology (2012) by Sharifi et al¹, questioning whether we should be considering tPA in patients other than those patients with massive pulmonary embolism (PE)? You know the big “Saddle Embolus” we all fear? Well it turns out this is only about 5% of all PEs.

Should we be considering tPA in patients with sub-massive PEs?

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By Salim Rezaie, MD|2019-09-10T13:37:21-07:00Mar 13, 2013|Cardiovascular, Pulmonary, Tox & Medications|

PE in pregnancy: which diagnostic tests do you use?

Pulmonary embolism (PE) can be a deadly disease and one of the most challenging diagnosis to make in a pregnant patient. Patients may present with signs and symptoms that might also be present in a normal uncomplicated pregnancy. Even in nonpregnant patients, the diagnosis of venous thromboembolism (VTE) such as PE can be quite challenging.

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By Javier Benitez, MD|2017-03-05T14:18:48-08:00Mar 6, 2013|Cardiovascular, Ob/Gyn, Pulmonary|

Patwari Academy videos: Demystifiying how ECGs work

As a nice segue from the Low Risk Chest Pain videos, below is a 3-part series on Demystifying the Electrocardiogram by Dr. Rahul Patwari. It takes talent to make the complex simple.
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