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Background:Myocardial infarction with nonobstructive coronaryarterydisease (MINOCA) is a special syndrome with clear evidence of myocardial ischemia, but no clear stenosis of coronaryartery imaging sign. Circulation, Volume 150, Issue Suppl_1 , Page A4143007-A4143007, November 12, 2024.
The first task when assessing a wide complex QRS for ischemia is to identify the end of the QRS. The ST segment changes are compatible with severe subendocardial ischemia which can be caused by type I MI from ACS or potentially from type II MI (non-obstructive coronaryarterydisease with supply/demand mismatch).
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
By Magnus Nossen, edits by Grauer and Smith The patient is a 70-something female with DMII, HTN and an extensive prior history of coronaryarterydisease and myocardial infarctions. ECG#1 Assessing ischemia on an ECG with wide QRS complexes (AIVR, ventricular pacing, BBB, etc) can be challenging. What do you think?
There is no definite evidence of acute ischemia. (ie, Simply stated — t he patient was having recurrent PMVT without Q Tc prolongation, and without evidence of ongoing transmural ischemia. ( If there had been ECG findings indicating reocclusion of the artery — an angiogram would have been warranted ).
IntroductionTransient Ischemic Attack (TIA) is a common neurologic condition characterized by temporary, focal cerebral ischemia that results in reversible neurological deficits without tissue infarction. from 2016‐2019 and secondary diagnosis of T2DM. Diabetics were more likely to be younger (70.43
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. Am J Med 2019, 132(5):622-630.
CT coronary angiography, in addition to a CT CAC, is arguably the best test for estimating whether someone has evidence of coronaryarterydisease and what that means for their near-term risk of a heart attack. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. N Engl J Med.
CTA head and neck were obtained and showed no evidence of intracranial hemorrhage, large vessel occlusion stroke (what a helpful and apt name for an acute arterial occlusion paradigm, by the way.), or basilar ischemia. Preliminary findings documented in the cath lab were “Anterior STEMI and no significant coronaryarterydisease.” (!!!)
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.
She requires maximal medical management per all current guidelines (including heparin and P2Y12 inhibitor per cardiology), as well as consideration for emergent cath in the case of persistent ischemia. I believe this is by far the most common outcome for this patient around the world in 2019. So what will you do for this patient?
Diffuse ST depression with ST elevation in aVR: Is this pattern specific for global ischemia due to left main coronaryarterydisease? Ischemia b. ST depression: is it ischemia? It was a baseline finding in 62% of patients, usually due to LVH. Reference: Knotts RJ , Wilson JM, Kim E, Huang HD, Birnbaum Y.
Hospital Course The patient was taken emergently to the cath lab which did not reveal any significant coronaryarterydisease, but she was noted to have reduced EF consistent with Takotsubo cardiomyopathy. Myocardial Infarction With Nonobstructive CoronaryArteries (MINOCA): The Past, Present, and Future Management [Internet].
These findings are concerning for inferior wall ischemia with possible posterior wall involvement. He was taken emergently to the cardiac catheterization lab and found to have multi-vessel coronaryarterydisease with a near-occlusive culprit lesion in the RCA, possibly reperfused. No significant changes, ongoing pain.
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. link] Park, J.,
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