chest pain

No Matter the Symptom, Local Cardiologist Pretty Convinced It’s an Anginal Equivalent

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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“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.”

  • Show Comments

  • Avatar
    Rahul Sharma

    Abhishek Khemka Neal Kumar Bhatia Kaustubh Dabhadkar

  • Avatar
    Rahul Sharma

    Abhishek Khemka Neal Kumar Bhatia Kaustubh Dabhadkar

  • Avatar
    Tracy Goodman

    Can you send that pist cardiac arrest back to the nursing home says another overworked Hospitalist!

  • Avatar
    Matthew T. Eaton

    That’s why when the ER doc orders a troponin on somebody with hand pain, he’s probably on the right track. ;-)

  • Avatar
    David Moore

    Brendan Newell

  • Avatar
    Terry Niska Watson

    Oh my gahhhh so funny! I remember a certain person who was just like this….everybody gets an echo and a stress test!

  • Avatar
    Andrew Tan

    Especially if they get paid.

  • Avatar
    Lora Ann Cullipher

    Chronic paper cut = Angioplasty

  • Avatar
    Katy Zanetti

    Love it!

  • Avatar
    Jeanette Polcz

    Lynn Zaremski

  • Avatar
    Steven Welsh

    I want one of those hankies with the QRS complex and peaked T wave design.

  • Avatar
    Bob King

    This is for you Geoffrey Corey

  • Avatar
    Pamela Saad

    Esta llenísima de verdad

  • Avatar
    Assad Daniel Saad Manzanera

    Pamela Saad Gil Martinez creo que les interesaría esta nota :p

  • Avatar
    Tamer N. Boules

    Funny how art imitates life…

  • Avatar
    Jessica Flood

    This sounds more like my ED attendings.

  • Avatar
    Alice Robinson

    My foot hurts …. It’s an MI stat EKG prep the cath lab… Does he have insurance? No … Wait it’s just an ingrown toe nail.

  • Avatar
    Varun Malyala

    Admitting diagnosis–chest pain
    DC diagnosis—rectal prolapse

  • Avatar
    Varun Malyala

    I’m sure that’s what ER thinks…

  • Avatar
    Juan Pablo Sanchez

    Yader Sandoval

  • Avatar
    Lora Ann Cullipher

    Alopecia = Dobutamine gtt

  • Avatar
    Henry Meilman

    Much truth is said in jest.

  • Avatar
    Jim Reginelli

    Like on web md everything is cancer

  • Avatar
    Katie Doherty

    Exertional constipation lmao! This hits close to home. So many doctors treat the lawyer and not the patient :/

  • Avatar
    Patrick Grizzly Campbell

    Thank God for lawyers! “The patient had an ingrown toenail doctor?” “Yes, that is why he presented to my office.” “And you didn’t even consider a cardiac event with this presentation?” “Respectfully counselor, it seems you and I went to very different medical schools….”

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