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Angiogram No obstructive epicardial coronaryarterydisease Cannot exclude non-ACS causes of troponin elevation including coronary vasospasm, stress cardiomyopathy, microvascular disease, etc. Registry data indicate that 6–11% of patients with acute MI have nonobstructive coronaryarteries.
This has been termed a “STEMI equivalent” and included in STEMI guidelines, suggesting this patient should receive dual anti-platelets, heparin and immediate cath lab activation–or thrombolysis in centres where cath lab is not available. aVR ST segment elevation: acute STEMI or not? Incidence of an acute coronary occlusion.
When total LM occlusion does present with STE in aVR, there is ALWAYS ST Elevation elsewhere which makes STEMI obvious; in other words, STE is never limited to only aVR but instead it is part of a massive and usually obvious STEMI. All are, however, clearly massive STEMI. This is her ECG: An obvious STEMI, but which artery?
Clinical Course The paramedic activated a “Code STEMI” alert and transported the patient nearly 50 miles to the closest tertiary medical center. The diagnostic coronary angiogram identified only minimal coronaryarterydisease, but there was a severely calcified, ‘immobile’ aortic valve. What do you see?
Circumstances attending 100 sudden deaths from coronaryarterydisease with coroners necropsies. Frick the ongoing ECG changes in association with hemodynamic collapse seemed out of proportion to the apparent coronary pathology. SanzRuiz, R., Solis, J., & & FernndezAvils, F. link] Bai, J., link] Myers, A., &
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