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Which Test is Best for Pain in the Chest?

R I Med J (2013)

February 2025

Professor of Medicine, Clinician Educator, Warren Alpert Medical School, Brown University; Associate Chief, Cardiology, Brown University Health Cardiovascular Institute, Providence, Rhode Island.

Chest pain is one of the most common chief complaints seen in both the emergency department (ED) and primary care settings.1,2 It is estimated that 20-40% of the general population will suffer from chest pain at some point throughout their lives.3 Interestingly although obstructive coronary artery disease (CAD) prevalence has declined, chest pain as a presenting symptom has become increasingly common over the last decade.

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Anomalous aortic origin of a coronary artery (AAOCA) comprises a set of rare congenital abnormalities in the origin or path of the coronary arteries with highly variable clinical implications. This is a pilot feasibility study where we investigated the influence of the anomalous coronary artery inlet architecture on coronary perfusion using coronary blood flow computational simulations to help predict the risk for coronary ischemia in patients with anomalous aortic origin of the right coronary artery (AAORCA) with these types of anomalous coronary artery inlet architectures. We developed a protocol for generating 3D models of patient coronary artery anatomies from an IRB-approved dataset of cardiac CT images of patients with AAORCA at our institution.

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Background: Children with Tetralogy of Fallot (TOF) usually present with right heart abnormalities, however much is not known if these children presents with left ventricular dysfunction.

Objectives: This article is aimed to ascertain the left ventricular function of children with TOF compared with those without any congenital heart disease. It also elicits the correlation if any, between left ventricular mass and descending aorta blood flow.

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