Chest Pain Evaluation: Rapid Diagnosis with ECG, POCUS, and Red Flags

What comes to your mind when a patient says, “I have chest pain”?
Myocardial infarction, aortic dissection, pulmonary embolism… all life-threatening diseases.
But in many cases, the cause is non-cardiac, like GERD or costochondritis.

When faced with such a scenario, would you be confident enough to immediately perform POCUS?
This article offers a practical framework to quickly identify life-threatening conditions using physical exams, bedside ultrasound (POCUS), and ECG—especially under time constraints in the ED or clinic.

🎯 What You’ll Learn:
Mastering the Emergency Approach to Chest Pain

• 🧠 Build a structured differential diagnosis of chest pain using the VITAMIN C framework
  — Learn to cover cardiac, vascular, pulmonary, GI, and musculoskeletal causes systematically.
• 🔍 Combine physical exam and POCUS to triage urgent vs. non-urgent causes
  — Master use of EF, RWMA, pericardial effusion, TRPG, E/e’, and lung sliding on bedside ultrasound.
• 📈 Interpret ST changes and match ECG findings with coronary territories and complications
  — Answer: “Which coronary artery?”, “What complication to expect?”, “Is this STEMI or NSTEMI?”

🩺 Doorway Information

72-year-old male / Main complaint: “Tight, squeezing chest pain”
BP: 96/52 mmHg, HR: 108 bpm, RR: 24, Temp: 36.9°C, SpO₂: 94% (room air)

💬 Patient’s Words

“The chest pain started just after I finished eating.
At first, I thought it was just my stomach, but the pain kept tightening and spread to my left shoulder.
I started sweating heavily… I knew something was wrong, so I came right away.”

🩺 Chest Pain: How to Quickly Identify Life-Threatening Conditions

In this case, we’re dealing with a classic high-risk profile: an elderly male with a squeezing chest pain radiating to the left shoulder, associated with diaphoresis and a hypotensive vital sign—all pointing toward acute myocardial infarction (AMI).

However, the fact that it started after a meal and was initially perceived as “stomach pain” raises the possibility of non-cardiac causes, such as esophageal spasm or biliary colic.

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🚨 Don’t Miss the “Five Killer Chest Pains”

When a patient presents with chest pain, always begin by ruling out the 5 Killer Chest Pains—conditions that can rapidly lead to death if missed:

1. Acute Coronary Syndrome (ACS)
2. Aortic Dissection
3. Pulmonary Embolism (PE)
4. Esophageal rupture
5. Tension Pneumothorax

These conditions are often grouped together in emergency medicine as “killer chest pain” syndromes.
Even if the pain seems atypical, if the vitals are unstable or something feels off, assume worst first.

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🔑 The core strategy: Always start by ruling out the big three vascular killers—ACS, aortic dissection, and PE or additional 2 ones.
Then assess for tamponade and pneumothorax using POCUS and chest auscultation.

Remember: Cardiac causes must be excluded before considering musculoskeletal or GI causes.
Never let a normal ECG or vague symptoms give false reassurance—perform focused ultrasound early and think in terms of red flags.

🔍 Clinical Reasoning: Fact / Problem / Hypothesis

🧾 Fact

• 72-year-old male
• Chest pain started after eating
• Described as “tight, squeezing” pain radiating to left shoulder
• Associated with diaphoresis and mild dyspnea
• SpO₂ 94%, BP 96/52, HR 108
• No trauma, fever, or cough

🤔 Problem (Reframed)

• Persistent, pressure-like chest pain with radiation and sympathetic activation
• Non-positional, non-pleuritic, and not reproducible → unlikely musculoskeletal or pleuritic
• Risk factors: elderly, male, diabetic, hypertensive, smoker

🧠 Hypothesis (VITAMIN C Framework)

• 🟥 Vascular: ACS (MI), Aortic Dissection, PE ★
• 🟧 Cardiac: Pericarditis, Cardiac Tamponade
• 🟨 GI: GERD, Esophageal Spasm, Biliary Colic, Pancreatitis
• 🟩 Others: Rib Fracture, Costochondritis, Herpes Zoster

🔎 NTK (Need To Know) at this point:

• Timing and duration: “How long did the pain last?”
• Quality and modifiers: “Does it change with movement or breathing?”
• Risk factors: DM, HTN, lipid profile, smoking history
• Associated symptoms: dyspnea, nausea, syncope
• Family history: sudden cardiac death, Marfan syndrome
• Medication/allergy history: especially anticoagulants, antiplatelets
• POCUS availability: EF, RWMA, pericardial effusion, IVC, lung findings

🗣️ Step 1: History Taking – From Symptoms to Red Flags

🧭 OPQRST for Chest Pain

Element	Purpose	Example Questions
O (Onset)	Sudden or gradual?	“When did the pain start?”
P (Provocation/Palliation)	Worse/better with?	“Does it worsen when you breathe or change position?”
Q (Quality)	Nature of pain	“Is it sharp, burning, squeezing, or stabbing?”
R (Radiation)	Spread to other areas?	“Does it radiate to your arm, jaw, or back?”
S (Severity)	Intensity	“How bad is the pain on a scale of 0 to 10?”
S (Associated Symptoms)	Red flags	“Any sweating, shortness of breath, nausea?”
T (Timing)	Duration and pattern	“Is the pain constant or does it come and go?”

🧑‍⚕️ PAM HITS FOSS – Background History Checklist

PAM (General Medical History)

• P: Past medical history (HTN, DM, dyslipidemia)
• A: Allergy (especially to contrast agents or meds)
• M: Medications (antiplatelets, anticoagulants)

HITS (Trauma & Hospitalization)

• H: Hospitalizations (AMI, PCI, surgeries)
• I: Injuries (chest trauma)
• T: Trauma history
• S: Surgeries (CABG, valve surgery)

FOSS (Social, Family, Gynecologic)

• F: Family history (sudden death, early MI)
• O: OBGYN (pregnancy, OCP use)
• S: Sexual history (HIV, IE risk)
• S: Social history:
  • Smoking
  • Occupation (stress, heavy labor)
  • Drugs (e.g., cocaine)
  • Alcohol use
  • Sleep (possible OSA)
  • Diet (high-fat, salty)
  • Stress (acute events, grief)
  • Exercise (pain triggered by exertion)
  • Checkups (regular screening)

🩺 Step 2: Physical Examination – What to Look for and Why

Once history suggests a potentially serious cause, physical exam becomes critical—not as a routine, but to test your hypotheses. Let’s approach it systematically from head to toe, with a focus on red flags and diagnostic clues.

👁️ General Appearance & Vital Signs

• Level of consciousness: drowsy, confused, fainting?
• Skin color: pale, cyanotic?
• Diaphoresis, labored breathing, use of accessory muscles
• Respiratory rate, pulse quality, and blood pressure differences
• Jugular venous distension: suggests tamponade or right heart failure
• Peripheral coldness, capillary refill > 2 seconds → Shock?

🫀 Cardiac Auscultation – Listen with a Purpose

• S3 (“Kentucky” gallop) → Volume overload (e.g., acute heart failure, mitral regurgitation)
• S4 (“Tennessee” gallop) → Stiff ventricle (e.g., hypertension, ischemia)
• Murmurs: new systolic murmur → papillary muscle rupture? Diastolic murmur → aortic regurgitation?
• Pericardial friction rub: scratchy, high-pitched sound → pericarditis

Tips: Use the bell lightly at the apex in left lateral position. Don’t delay auscultation—listen early and thoroughly.

🫁 Lung & Peripheral Exam

• Breath sounds: decreased → pneumothorax or effusion?
• Rales or crackles → pulmonary edema
• Wheezes → asthma, PE, or cardiac asthma
• Leg swelling, asymmetry → suspect DVT and PE

📉 ECG Interpretation – Know What to Match

Leads	Wall	Coronary Artery
II, III, aVF	Inferior	RCA
V1–V2	Septal	Proximal LAD
V3–V4	Anterior	Mid LAD
V5–V6, I, aVL	Lateral	LCx
V7–V9	Posterior	RCA or LCx

• Inferior MI → Watch for AV block (RCA)
• Septal MI → Risk of ventricular septal rupture (proximal LAD)
• Lateral/Posterior → Risk of papillary muscle rupture → MR

🩻 POCUS – Point-of-Care Ultrasound in Action

Approach POCUS with four key goals:

1. Circulatory Assessment (EF, RWMA)
   • Eyeball EF → is the LV squeezing normally?
   • Regional Wall Motion Abnormalities (RWMA) → ischemia
2. Volume/Fluid Overload (Diastolic Dysfunction)
   • E/A Ratio: A > E → impaired relaxation
   • e’ & E/e’ Ratio: E/e’ > 15 suggests high LA pressure
   • B-lines on lung → pulmonary edema
3. Right Heart Strain (for PE)
   • TAPSE < 16 mm → RV dysfunction
   • McConnell’s sign → specific for PE
   • D-shaped LV → RV pressure overload
4. Exclude Deadly Diagnoses
   • Pericardial effusion with RV collapse → tamponade
   • No lung sliding + barcode sign → tension pneumothorax

🔰 Must-Have POCUS Skills for Interns

• Eyeball EF – estimate LV contractility visually
• RWMA – detect regional dysfunction
• Diastolic function – E/A, e’, E/e’ for preload estimation

In time, you’ll be able to “listen with your eyes” and see what the heart is trying to tell you.

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🧪 Step 3: Investigations – Targeted Testing Based on Your Hypothesis

Once history, physical exam, ECG, and POCUS give you a working diagnosis, it’s time to confirm or exclude it with labs and imaging. But remember: don’t test everything—test what matters.

🔍 1. Strategy First: Why Are You Testing?

• Suspect ACS? → Order Troponin
• Need to exclude PE or aortic dissection? → D-dimer → CT with contrast
• Infection possible? → WBC, CRP

When your hypothesis is clear, test selection becomes simple and defensible.

💉 2. Key Blood Tests to Order

• Troponin I/T – essential for ACS; can be normal in early phase → repeat after 3–6 hrs
• D-dimer – screen for PE and dissection (interpret with Wells score or pre-test probability)
• WBC, CRP – elevated in pneumonia, pleuritis, or pericarditis
• CK-MB – used for reinfarction or special cases
• BNP, NT-proBNP – suggestive of HF if patient has chest pressure with crackles or edema

🕒 Timeline of Cardiac Markers

Marker	Rise	Peak	Normalize	Note
Troponin I/T	3–6 hrs	12–24 hrs	7–10 days	Repeat if <3 hrs since onset
CK-MB	3–6 hrs	12–24 hrs	2–3 days	Useful for reinfarction
Myoglobin	1–3 hrs	6–12 hrs	Within 24 hrs	Fastest rise but low specificity

🔬 3. Imaging: Choose Purposefully

• Chest X-ray – pneumothorax, pneumonia, cardiomegaly, aortic contour
• Contrast-enhanced CT – best for PE and aortic dissection (if stable)
• Emergency CAG – for STEMI: aim for door-to-balloon time < 90 min

🩸 4. Additional Labs for Safety & Management

Even once the diagnosis is made, order these to prepare for interventions like PCI:

Test	Purpose
CBC (WBC, Hb, Plt)	Bleeding risk, anemia, infection
PT-INR / APTT	Check for anticoagulation status
Na / K / Mg / Ca	Prevent lethal arrhythmias
AST / ALT	Rule out liver dysfunction or check for cardiac enzyme overlap
Cr / BUN	Check renal function before contrast
Blood Type & Crossmatch	Prepare for transfusion if needed

🧪 5. ABG & Blood Glucose – Don’t Forget the Basics

• Lactate – marker of hypoperfusion (↑ in AMI, PE, shock)
• Acidosis – metabolic acidosis may indicate shock or DKA
• Respiratory alkalosis – seen in PE or panic attacks
• VBG – sufficient for screening (pH, lactate ≈ ABG)
• Blood glucose – both hyper- and hypoglycemia worsen outcomes in ACS

💡 Tips & Pitfalls

• Normal troponin doesn’t rule out ACS in early phase → repeat testing is critical
• D-dimer is not a magic test → avoid overuse unless pre-test probability supports it
• Imaging without a hypothesis leads to “CT scatter” → base decisions on clinical reasoning
• Exams and bedside tools like POCUS remain more valuable than labs alone

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🩺 Case Review: Let’s Apply What We’ve Learned

So far, we’ve walked through a structured approach to chest pain across history taking, physical exam, and diagnostic testing. Now, let’s revisit our initial case and apply each step in real time.

📍 Doorway Information (Recap)

• 72-year-old male
• Chief complaint: Tight, squeezing chest pain
• BP 96/52, HR 108, RR 24, Temp 36.9°C, SpO₂ 94% (room air)

From this doorway snapshot, we should already be thinking: “This might be ACS.” But let’s dig deeper using our NTK checklist and structured questioning.

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🗣️ Step 1: History Taking

Doctor: “Can you tell me when the chest pain started?”
Patient: “It began about 30 minutes ago, right after I finished eating.”

Doctor: “How would you describe the pain?”
Patient: “It’s like a tight band across my chest… and now it’s spreading to my left shoulder. I’m sweating a lot too.”

→ At this point, we’re already concerned about ischemic chest pain. Let’s clarify some red flags and rule out mimickers.

Doctor: “Does the pain change with breathing or movement?”
Patient: “No, it stays the same.”

Doctor: “Any past history of heart or vascular disease?”
Patient: “I have high blood pressure and diabetes. I also smoke—one pack a day for 40 years.”

Doctor: “Any other symptoms like shortness of breath or nausea?”
Patient: “Yes, I feel a little breathless and nauseated.”

🧠 Summary

• Fact: Prolonged squeezing chest pain after meals, radiating to the shoulder, with diaphoresis and mild dyspnea. History of DM, HTN, smoking.
• Problem: Ongoing, non-positional, pressure-type pain with sympathetic signs and atherosclerotic risk.
• Hypothesis: ACS (STEMI/NSTEMI), Aortic Dissection, PE, Pericarditis, GERD

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🩺 Step 2: Physical Examination

• General appearance: Pale, diaphoretic, uncomfortable
• Heart sounds: S1/S2 audible, no murmur, no S3 or S4, no pericardial friction rub
• Breath sounds: Clear bilaterally, no crackles or wheezes
• Extremities: Cool to touch, weak rapid pulse
• JVD: Slightly distended
• Abdomen: Soft, non-tender, no radiation from abdomen

🧠 Interpretation

No clear signs of PE or dissection; no pulmonary edema; but signs of hypoperfusion and borderline shock.

📉 ECG

• ST elevation in V2–V5 → anterior MI
• T wave inversion in some leads
• No pathological Q waves yet

🩻 POCUS Findings

• Reduced LV contractility (kissing wall absent)
• RWMA in anterior wall
• E/A = E > A, E/e’ = 13 → suggests elevated LA pressure
• IVC mildly plethoric
• No pericardial effusion, normal lung sliding

Conclusion: Findings are consistent with anterior wall myocardial infarction with early signs of cardiogenic shock.

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🧪 Step 3: Labs & Imaging

• Troponin I: Elevated (4.2 ng/mL)
• CK-MB: Elevated (38 U/L)
• BNP: 420 pg/mL → supports LV dysfunction
• D-dimer: Negative
• Lactate: 3.8 mmol/L → tissue hypoperfusion
• Glucose: 198 mg/dL

Additional labs (CBC, electrolytes, renal function, coagulation) were also ordered to prepare for emergency intervention.

🖼️ Imaging

• Chest X-ray: No cardiomegaly, no signs of pulmonary edema or dissection
• CAG (Cath Lab): 90% stenosis in proximal LAD (#6) → PCI performed

🧠 Final Diagnosis

Anterior STEMI with early cardiogenic shock due to reduced EF and elevated lactate.

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📞 When to Refer to a Specialist – Don’t Wait Too Long

Not all chest pain requires a cardiology consult—but when it does, time is of the essence.
Here’s a guide to recognizing when to refer, which department to contact, and what to prepare.

🚩 Cases That Require Urgent Referral

• Unstable vital signs (e.g., hypotension, tachypnea, hypoxia)→ Think: ACS, PE, Aortic Dissection, Shock➤ Refer to Emergency Medicine, Cardiology, or Cardiovascular Surgery
• Ongoing chest pain with ECG or POCUS abnormalities→ Possible STEMI, NSTEMI, myocarditis➤ Refer to Cardiology immediately
• Sudden severe chest pain radiating to the back with BP discrepancy→ Aortic Dissection➤ Refer to Cardiothoracic Surgery or Emergency
• Pleuritic chest pain with abnormal chest X-ray→ Possible PE, pneumothorax, pleuritis➤ Refer to Pulmonology or Emergency
• Pericardial effusion or fever with chest pain→ Suspect pericarditis, myocarditis, or endocarditis➤ Refer to Cardiology or Infectious Disease
• Chest pain on exertion with new murmur→ Aortic stenosis, HOCM, mitral regurgitation➤ Refer to Cardiology
• History of malignancy or immunosuppression + atypical chest pain→ Consider tumor invasion, bone metastasis, or herpes zoster➤ Refer to Oncology, Orthopedics, or Dermatology
• No organic cause found + panic symptoms→ Rule out physical disease first➤ If necessary, refer to Psychiatry or Psychosomatic Medicine

🧠 Three Key Questions Before Referring

1. Are there any red flags?
   (Could this be life-threatening?)
2. Is this beyond the scope of primary care?
   (PCI, surgery, inpatient management required?)
3. Are there social reasons for referral?
   (Elderly, lives alone, nighttime presentation?)

📌 Remember: Don’t wait for a confirmed diagnosis to initiate referral.
Refer early when the suspicion is strong.

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📝 Tips & Clinical Pearls: Chest Pain Wisdom You’ll Use Every Day

🧭 Practical Tips for Evaluating Chest Pain

• 🔍 Look beyond “chest pain”: Often, associated symptoms (e.g., dyspnea, nausea, fatigue, shoulder pain) hold the diagnostic key.
• ⚠️ Don’t trust a normal ECG too early: Initial ECGs can be falsely reassuring, especially in posterior MI, NSTEMI, or early ACS.
• 📞 Refer before you’re 100% sure: Don’t wait for confirmation—if your gut says “this isn’t right,” act on it.
• 🖐️ Feel the pulse, check both arms: Don’t forget to assess for pulse deficits or BP asymmetry—clues for dissection.
• 🩺 Listen early: Auscultate in the first minute—delays cost valuable information.
• 🧪 Repeat troponin and ECG: One test doesn’t rule out MI. Always time your tests according to symptom onset.
• 🫀 POCUS is your friend: Practice scanning EF, RWMA, IVC, and pericardial fluid until it’s second nature.

💡 Clinical Pearls – Memorable Quotes with Lifesaving Meaning

“Common things are common.”
— William Osler

Always consider ACS first. Just because GERD is frequent doesn’t mean MI is rare.

“Absence of evidence is not evidence of absence.”
— Carl Sagan

A normal ECG or troponin does not rule out ACS. Repeat. Observe. Reassess.

“Treat the patient, not the number.”
— Attributed to William Osler

Don’t be distracted by lab values. Focus on the patient’s symptoms, color, expression, and context.

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🗣️ OET Speaking Session – Chest Pain (Possible ACS)

👥 Scenario

You are a doctor in an emergency department. A 72-year-old man presents with a 30-minute history of chest tightness that started after dinner. He feels sweaty and slightly breathless. His vital signs show hypotension and mild tachycardia.

You suspect acute coronary syndrome (ACS), but you also need to consider other serious causes like aortic dissection or pulmonary embolism.

🎯 Your Task

• Explore and clarify the patient’s symptoms and medical history
• Explain the possible diagnoses and the need for urgent evaluation
• Reassure the patient and address emotional concerns
• Inform the patient about the next steps (tests, monitoring, possible admission)

💬 Sample Statements for Each Task

• Exploring symptoms: “Can you describe exactly how the pain feels?” / “Did it come on suddenly or gradually?”
• Explaining urgency: “Your symptoms raise concern for a heart-related issue, so we want to act quickly and carefully.”
• Reassurance: “You did the right thing by coming in promptly. We’re here to support you and manage this safely.”
• Next steps: “We’ll do an ECG, blood tests, and an ultrasound to check how your heart is functioning. Based on that, we may need to involve the cardiology team.”

💬 Common Patient Cues & Sample Doctor Responses

🧠 Challenging Questions & Sample Doctor Responses

✉️ OET Writing Task – Sample Referral Letter

Today’s Date

Dr. James Liu
Cardiology Department
Metro City General Hospital

Re: Mr. Hiroshi Tanaka, 72 years old

Dear Dr. Liu,

I am referring Mr. Hiroshi Tanaka, a 72-year-old man, for urgent cardiology evaluation with suspected acute coronary syndrome.

He presented to our ED with a 30-minute history of chest tightness following dinner. The pain was described as a squeezing sensation radiating to the left shoulder, accompanied by diaphoresis and mild dyspnea. He denied recent trauma or fever.

His past medical history includes hypertension and type 2 diabetes mellitus. He has a 40-pack-year smoking history. On examination, his BP was 96/52 mmHg and HR 108 bpm. ECG showed ST elevation in V2–V5, and bedside ultrasound revealed reduced EF and anterior wall hypokinesis. Troponin I was elevated at 4.2 ng/mL. Lactate was also elevated (3.8 mmol/L).

We have initiated IV access, oxygen therapy, and antiplatelet treatment. He is hemodynamically borderline and may benefit from urgent coronary angiography and PCI.

Thank you for your prompt assessment and management.

Yours sincerely,

Dr. [Your Name]
Emergency Physician

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🧭 Summary & Take-Home Messages – What You Should Remember

Chest pain is one of the most common chief complaints — but also one of the most dangerous to underestimate.

Throughout this article, we focused on how to safely and systematically evaluate chest pain using:

• 🗣️ Structured history taking – Use OPQRST and red flag screening to assess urgency
• 🩺 Focused physical exam + POCUS + ECG – Detect critical signs before they’re obvious
• 🧪 Targeted investigations – Don’t overtest, don’t undertest. Let your hypothesis lead
• 📞 Timely referral – Don’t wait for a confirmed diagnosis. Act early if the suspicion is strong

✅ Your Chest Pain Checklist

• Rule out the “5 Killer Chest Pains”: ACS, aortic dissection, PE, esophageal rupture, pneumothorax
• Recognize that ACS can present atypically – especially in the elderly, diabetics, and women
• POCUS is not just “nice to have” – it’s a life-saving bedside tool
• Reassess, repeat, recheck – Troponin and ECG may evolve over time
• Don’t get distracted by normal numbers – Focus on the patient in front of you

💡 Final Message

Mastering chest pain evaluation isn’t about memorizing lists.
It’s about building a habit of thinking clearly under pressure, recognizing danger early, and acting decisively.

Even just applying one lesson from this article — like using POCUS for EF or not ignoring mild ST changes — may help you save a life.

🩺 Chest pain will walk through your door again.
The next move is yours.

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🔬 Bonus Column: Advanced Application of POCUS – Can Doppler Echo Assess Coronary Flow?

In recent years, transthoracic Doppler echocardiography (TTE-Doppler) has gained attention as a tool for non-invasive assessment of coronary flow velocity, particularly in the left anterior descending (LAD) artery.

🫀 Key Parameters in Coronary Flow Assessment

• Resting Coronary Flow Velocity (CFV):
  – Measured in the mid-to-distal LAD
  – Normal range: approximately 31 ± 12 cm/s
  – Some studies suggest CFV >32 cm/s may be associated with poorer prognosis in chronic coronary syndromes
• Coronary Flow Velocity Reserve (CFVR):
  – Calculated as: CFVR = Hyperemic CFV ÷ Resting CFV
  – Hyperemia induced by dipyridamole or adenosine
  – A CFVR ≤2.0 is considered indicative of microvascular dysfunction

🔍 Clinical Relevance

• Useful in evaluating patients with angina but no clear coronary stenosis (e.g., ANOCAD)
• May help identify coronary microvascular dysfunction in real time
• Potential role in follow-up and therapeutic response monitoring

⚠️ Limitations and Current Position

• Primarily applicable to the LAD – visualization of RCA or LCx is often difficult
• Operator-dependent and technically challenging – requires training and standardization
• Currently serves best as a supplementary assessment tool rather than a replacement for CAG

💡 Takeaway

While TTE Doppler coronary flow assessment is still in the research phase, it opens exciting possibilities for non-invasive evaluation of coronary circulation.
It may not replace angiography, but in select patients, it can complement bedside ultrasound and improve diagnostic precision.

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🔗 Related Articles – Learn More from Similar Symptoms

• Palpitations: Is It Cardiac or Not?
• Edema: A Systematic Approach to Swelling
• Cough: Acute and Chronic Causes Explained
• Fatigue: Diagnosing the Invisible

Looking for the Japanese version of this article?
👉 ▶︎ 胸痛の診かた｜身体所見とPOCUSから始める初期評価

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🩺 Want to practice your consultation and reasoning skills for chest pain?

👉 Try these 4 realistic Mock Patient Scripts for OSCE and OET preparation:
“It feels like something is pressing on my chest…” — Chest Pain Mock Scenarios

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📚 References

1. UpToDate. Evaluation of the adult with chest pain in the emergency department. https://www.uptodate.com
2. Japanese Circulation Society. Guidelines for the Management of Acute Coronary Syndromes (2022).
3. Douglas PS et al. Coronary flow reserve by transthoracic Doppler ultrasound: a tool for detection of coronary microvascular dysfunction. J Am Coll Cardiol. 2002.
4. Amal Mattu’s ECG Weekly Workout. https://ecgweekly.com
5. Japanese Society of Echocardiography. Textbook of Echocardiography, 2nd Edition.