ATLANTA, GA – No matter the symptom, no matter the severity, and no matter the location, onset, or duration, local cardiologist Willie McCray is pretty convinced that your complaint, whatever and wherever it may be, is an anginal equivalent, no doubt about it.
And he’s not shy about telling you why.
“Chest pain’s so obvious, it’s old news, man,” says McCray while buffing his gold-plated calipers. He sits at his desk, which is well lit with a C-Arm, intent on making his calipers completely sterile. “Anything can be an anginal equivalent. Anything.”
Most clinicians (cardiologists included) consider dyspnea, diaphoresis, or fatigue, particularly with exertion, anginal equivalents reflecting myocardial ischemia. More often than not, it warrants further workup with electrocardiogram (ECG) and cardiac enzymes, and sometimes even a stress test, transthoracic echocardiogram (TTE), or cardiac catheterization. But McCray warns clinicians (cardiologists included) that it’s foolish to stop there.
“When someone complains about the sniffles, you know what I think about?” McCray asks rhetorically, as he flips through the last few pages of his favorite comic Captain Cath & The Evil Echos. “Angina, no doubt about it. Why not allergic rhinitis? Too obvious.”
If you ask McCray what he thinks about symptoms like runny eyes, tongue swelling, or hair loss, he looks you right in the eye and answers with immediate conviction: “You show me a symptom and I’ll show you a perfusion defect.”
McCray V-paces around his office as he relays the story of a healthy 28-year-old-male with no past medical history, family history, or drug use who presents with a right first toe blister after running a half marathon. Worried about an atypical presentation of a large anterior myocardial infarction complicated by cardiogenic shock, the patient was taken for emergent cardiac catheterization where was he found, unexpectedly, to have clean coronary arteries.
“But imagine if he didn’t have clean coronaries,” explains McCray as he stops and admires his Kiss the Chef lead vest with matching intra-aortic balloon pump (IABP). “That would’ve been embarrassing to attribute the blister to mechanical injury.” He points at his head with his index finger. “That’s why you have to think outside the box.”
If you ask McCray what symptom scares him the most, he is very quick to answer back: constipation. More specifically, exertional constipation.
“When I hear about a case of exertional constipation, it almost puts me in complete heart block,” comments McCray with a quiver in his voice and sweat forming on his brow. He takes a seat, wipes his forehead with a handkerchief embroidered with QRS complexes and peaked T waves, and exhales. “You better believe I want CT surgery back-up. That sh*t’s for real.”