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To: LindyBill who wrote (341015)	1/2/2010 11:27:45 AM
From: skinowski	Read Replies (1) \| Respond to of 793927

You KNOW they would have stented at ANY sign of a possible problem with him No doubt about that. However, the ST segment elevation on the EKG is not always 100% clear. It can be "borderline", "possible", etc. It is eyeballed and measured by human beings. Depending on clinical presentation, it may be wise to err on the side of reading the EKG as positive. Not sure it would be fair to interpret their action as overkill based only on ex post facto findings. A person may have ST segment elevation for other reasons, like coronary artery spasm. In this case, the cath may be negative. Let's see how it sounds once more details come out. mayoclinic.com Question Coronary artery spasm: What is it? What is a coronary artery spasm? Answer from Martha Grogan, M.D. A coronary artery spasm is a brief, temporary tightening (contraction) of the muscles in the artery wall. This can narrow and briefly decrease or even prevent blood flow to part of the heart muscle (myocardium). If the spasm lasts long enough, it can lead to chest pain (angina) and possibly a heart attack (myocardial infarction). These spasms may also be referred to as Prinzmetal angina or variant angina. Unlike typical angina, which usually occurs with exertion, coronary artery spasms often occur at rest. Coronary artery spasms occur most often in people with risk factors for heart disease, such as tobacco use, high cholesterol and high blood pressure. They may also be associated with other diseases, such as lupus. Coronary artery spasms may be triggered by tobacco use, exposure to cold, extreme emotional stress and use of illicit stimulant drugs, such as amphetamines and cocaine. Treatment of coronary artery spasms may include medications such as nitrates, calcium channel blockers and 1-arginine, which may reduce the risk of recurrence. You can also reduce your risk by discontinuing tobacco use and controlling high cholesterol and high blood pressure.

To: LindyBill who wrote (341015)	1/2/2010 11:52:31 AM
From: skinowski	3 Recommendations Read Replies (1) \| Respond to of 793927

A little personal story - to illustrate the issue. Not long ago ago I was called to the ED to admit a patient with chest pains. He was a 39 year old man, slightly overweight, perspiring, pale. He had a history of high cholesterol, hypertension, and he was a smoker. Strong family history of heart problems. The guy was experiencing severe pressure-like pain - as if someone heavy was sitting on his chest. He felt it was hard to breath. His EKG revealed only very vague, non-specific changes. His cardiac enzymes were negative. I had to trust my instincts (based on 30+ years in the trenches). I overruled the ER doc (who later thanked me) and instead of admitting the man arranged for an emergency Angio. It turned out that he had a complete block of his proximal Anterior Descending artery (aka the Widow Maker). The man was on his way to develop a huge heart attack. I think invasive Cardiologists do amazing stuff. I've seen plenty of people who would be otherwise dead or severely damaged - go home in a day or two, after having angioplasty, practically intact.