 Okay, day 16 out of 30 of our pants review challenge here. We're going to ask Elijah something, see if he knows this one. Elijah, what is, hopeful, right? Give me an easy one. Give me an easy one. I mean, if you know it, it's easy. So Elijah, what is Prins metal angina? Otherwise known as vasospastic angina. Vasospastic angina. There it is. Come on, focus there. Prins metal or vasospastic angina? What is it? I'm going to go with the golden response though. I don't know. All right, let's get the, let's give the viewer like a few seconds to think of an answer. What is Prins metal or vasospastic angina? Alrighty, Prins metal or vasospastic angina is a spasm of the LAD, the left, left, is that LAD, the widow maker? Yeah, the widow maker. Yeah, the widow maker. So vasospastic angina or Prins metal angina is a spasm of the left anterior descending artery, the LAD, or the right coronary artery. So one of those two arteries, the LAD or the right coronary, the symptoms are a squeezing pressure chest pain at rest. So that's a big one. It's not like hypertrophic cardiomyopathy where the typical presentation is a athletic 17-year-old who collapses on the basketball court clutching his chest. This is at rest, okay? So the person starts clutching their chest, they have the squeezing pressure chest pain at rest. Diagnosis, excuse me, I've been talking too long without water. Diagnosis is transient ST elevation during episodes and normal EKG normal tracing without episodes. So it's at rest, the person is just in their hospital bed, their EKG, their tracing is totally normal, no ST elevations, normal sinus reddom, everything's normal. And then suddenly they start getting symptoms and you notice ST elevations during those episodes and then they spontaneously go away and you're like, what the hell's going on? Are you having a heart attack or are you not? Oh, you are. Okay, a few minutes later, now you're not. What the heck's going on? This is weird, vasospastic angina. Normal troponin, normal troponin and the stress test may or may not be positive. They might get an episode during the stress test or they might not and it might be a normal stress test and you're like, what is happening with this person? This person is presenting like they're having isstemi, but then all the symptoms just go away. So it's weird. So it's vasospastic. The symptoms are caused by spasm of the LED or the right coronary and one major, major, major, major risk factor is cocaine use. Oh wow, okay. Okay, so especially a young person comes in looking like they were having a heart attack and might even during the EKG be having one or during the tracing might be having one, SD elevation, but they come back with a normal troponin and then you ask them like, hey, you don't use cocaine, do you? And they're like, yeah, I do. Could be vasospastic or Prince metal angina. That's interesting. Yep. And one funny little tidbit that the viewer will never, ever forget because I'll never forget it. We had a lady who admitted to cocaine use who was 78 years old. Cool. Might have even been in her 80s but I want to say she was like high 70s. 80 year old female admitted to, yeah, I use cocaine regularly. And we're like, oh, okay. Well, now your chest pain workup just changed a little bit. So anyways, for chest pain, you're always asking about cocaine use. And the reason you're always asking about cocaine use is because it can exacerbate or even cause vasospastic angina otherwise known as Prince metal angina. That's day 16. Oh man. Well, I like it because you're talking about the LED in the right corner area. And I'm like, okay. I remember the picture in the slides. I know what we're talking about. But like, you're talking about like the EKG findings and I'm like, oh, I'm so excited this next semester I'm going into that. So. Oh, absolutely. Yeah, EKGs are, I forgot a lot of it at this point. A lot of them. And I just know like transfer or not transfer is this something extremely important versus not extremely important critically right now. I know that much. But in the hospital, you're definitely learning way more than what I'm doing right now. But anyway, Prince metal angina or vasospastic angina. I'll never forget it. Absolutely.