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A triphasic left ventricular filling pattern with an additional mid diastolic wave, called T wave by some authors and L wave by others, can occur in situations of left ventricular diastolic dysfunction, especially in hypertrophic cardiomyopathy. 2011 Dec;19(4):169-73. Initial stages (I to III) are considered reversible with treatment.
In this abstract from 2011, we found that 4%(4 of 99) type 2 MI and 38% of type 1 MI had ST Elevation. I said I think there is a fixed stenosis in the LAD and the tachycardia and stress caused a type 2 STEMI. link] An angiogram was done: It showed no culprit and no coronary disease, but did show a myocardial bridge in the mid LAD.
By ECG alone: it is suspicious for stress cardiomyopathy, or takotsubo, due to the diffuse ST Elevation: II, III, aVF AND I and aVL. Subarachnoid hemorrhage causes extreme central catecholamine output, resulting in stress cardiomyopathy, just like takotsubo. This is unusual in acute OMI. she had severe pulmonary edema.
Whenever I see PVCs with the morphology and axis seen in todays case I always look for signs of AC ( Arrhythmogenic Cardiomyopathy ). Arrhythmogenic cardiomyopathy often manifests with PVCs from the RV. The ECG in Figure-1 however, shows no signs of arrhythmogenic cardiomyopathy. Try a different kind of antiarrhythmic.
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