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Atherosclerotic cardiovascular disease (ASCVD), caused by plaque buildup in arterial walls, is one of the leading causes of disability and death worldwide.1,2 1,2 ASCVD causes or contributes to conditions that include coronaryarterydisease (CAD), cerebrovascular disease, and peripheral vascular disease (inclusive of aortic aneurysm).3
The diagnostic coronary angiogram identified only minimal coronaryarterydisease, but there was a severely calcified, ‘immobile’ aortic valve. DISCUSSION: The 12-lead EKG EMS initially obtained for this patient showed severe ischemia, with profound "infero-lateral" ST depression and reciprocal ST elevation in lead aVR.
Angiogram No obstructive epicardial coronaryarterydisease Cannot exclude non-ACS causes of troponin elevation including coronary vasospasm, stress cardiomyopathy, microvascular disease, etc. Detailed coronaryartery evaluation not performed. This suggests further severe ischemia.
His response: “subendocardial ischemia. Smith : It should be noted that, in subendocardial ischemia, in contrast to OMI, absence of wall motion abnormality is common. With the history of Afib, CTA abdomen was ordered to r/o mesenteric ischemia vs ischemic colitis vs small bowel obstruction. Anything more on history?
Post by Smith and Meyers Sam Ghali ( [link] ) just asked me (Smith): "Steve, do left main coronaryartery *occlusions* (actual ones with transmural ischemia) have ST Depression or ST Elevation in aVR?" Here I explain: First, you don't know for certain what the state of the artery was at the time of the ECG.
It is possible there is microvascular dysfunction producing residual transmural ischemia. But this is most common when there is prolonged ischemia, and this patient had the fastest reperfusion imaginable! Circumstances attending 100 sudden deaths from coronaryarterydisease with coroners necropsies. SanzRuiz, R.,
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