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CardioNerds\xa0(Amit Goyal\xa0&\xa0Daniel 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. \n\n\n\nThis case has been published in JACC Case Reports!\n\n\n\nCollect free CME/MOC credit just for enjoying this episode! \n\n\n\n\n\nJump to: Patient summary - Case media - Case teaching - References \n\n\n\nEpisode graphic by Dr. Carine Hamo\n\n\n\n\n\n\n\n\n\nCardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll\n\n\n\n\n\nCardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron!\n\n\n\n\n\n\n\n\n\nPatient Summary\n\n\n\nA\xa0woman in her early 30s\xa0with a past medical history of Hashimoto's thyroiditis and one prior miscarriage at\xa0<8 weeks\xa0presented 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\xa0Cardionerds\xa0for 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!\xa0\xa0 For a detailed course, enjoy the JACC case report. \n\n\n\n\n\n\n\nCase Media\n\n\n\n\nVisit the JACC Case Reports to review the case media! \n\n\n\n\n\n\n\n\nEpisode Schematics & Teaching\n\n\n\n\n\n\n\n\n\n\n\nThe CardioNerds 5! \u2013 5 major takeaways from the #CNCR case\n\n\n\n1. How Do We Evaluate Chest Pain in Younger Patients\xa0\n\n\n\nStart with the same things as everyone else!\xa0 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:\xa0https://clinicalproblemsolving.com/dx-schema-chest-pain/).\xa0\xa0\xa0Of course it is important to think about non-life threatening etiologies as well \u2013 esophageal spasm, gastric ulcer, rib fracture, skin lesion, among many others - given that high-risk chest pain is less likely in younger adults.\xa0\xa0While less common,\xa0acute coronary syndrome is not uncommon in young patients,\xa0as 23% of patients with MI present at age <55 years.\xa0\xa0\n\n\n\n2. What About Chest Pain in Women?\xa0\xa0\n\n\n\nAs has been discussed on the\xa0Cardionerds\xa0podcast (Listen to episodes with Dr. Nanette Wenger, Dr Martha Gulati, and Dr. Leslie Cho),\xa0women 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.\xa0In one study of young patients with acute MI, women \u2013 19% of\xa0cases overall \u2013 were less likely to undergo revascularization or receive guideline-directed therapy\xa0The 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\xa0ways.\xa0\xa0While 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\xa0compared with men.\xa0\xa0Furthermore, while obstructive epicardial disease remains the primary cause of acute MI in young women,