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The ECG does not show any definite signs of ischemia. Uncontrolled coronary spasm may be associated with serious arrhythmias , including cardiacarrest ( Looi et al — Postgrad Med, 2012 ; Tan et al — Eur Heart J Case Rep, 2018 ; Chevalier et al — JACC, 1998 ; Rodriguez-Manero — EP Europace, 2018 ).
Remember, in diffuse subendocardial ischemia with widespread ST-depression there may b e ST-E in lead s aVR and V1. There are well formed R-waves with good voltage/amplitude which is uncommon for ischemia. Smith: This bizarre ECG looks like a post cardiacarrest ECG with probable acidosis or hyperkalemia in addition to OMI.
Followup ECG: No Change Absence of evolution is the best evidence against ischemia as the etiology. I was taught that the tell-tale sign of ischemia vs an electrical abnormality was in the hx, i.e. chest pain for the ischemia and potential syncope for brugada. Ischemia/infarction. Electrocardiol 45:433-442, 2012 ).
These include ( among others ) — acute febrile illness — variations in autonomic tone ( as may occur with syncope ) — hypothermia — ischemia or infarction — cardiacarrest — and electrolyte disorders ( especially hyperkalemia — but also hypokalemia/hyponatremia ). Circulation, 117, 1890–1893. [3]: Fever and Brugada syndrome.
In addition to a spontaneous or induced Brugada-1 ECG pattern, criteria for B rugada S yndrome require one or more of the following: History of cardiacarrest, of polymorphoic VT, or of non-vagal syncope — positive family history of sudden death at an early age — a similar ECG in close relatives. Circulation, 117, 1890–1893. [3]:
Occurrence of “J Waves” in 12-Lead ECG as a Marker of Acute Ischemia and Their Cellular Basis. Europace 2012 Shinde R, Shinde S, Makhale C, Grant P, Sathe S, Durairaj M, Lokhandwala Y, Di Diego J, Antzelevitch C. Occurrence of "J waves" in 12-lead ECG as a marker of acute ischemia and their cellular basis.
The patient was unconscious BEFORE the cardiacarrest, at the same time that she had strong pulses. Therefore, cardiacarrest is NOT the etiology of the coma. More cases here to highlight: [link] Middle Aged Woman with Asystolic CardiacArrest, Resuscitated: Cath Lab? OMI is a clinical diagnosis.
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