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Post cath ECG: Now there are hyperacute T-waves again, and recurrent ST depression in V2 This ECG would normally diagnostic of OMI until proven otherwise No further troponins were measured, but it looks like there is recurrent OMI Next day: A CT CoronaryAngiogram was done (CTCA) CARDIAC MORPHOLOGY AND FUNCTION: 1. IMPRESSION: 1.
Bedside cardiac ultrasound showed moderately decreased LV function. Finally, do a coronaryangiogram Possible alternative to pacing is to give a beta-1 agonist to increase heart rate. For more on Torsades de Pointes vs PMVT See My Comment in the October 18, 2023 post and the September 2, 2024 post in Dr. Smith's ECG Blog ).
Pads were placed with ultrasound guidance, so they were in the correct position. Cardiology was consulted and the patient underwent coronaryangiogram which showed diffuse severe three-vessel disease. Coronaryangiogram shows diffuse severe three-vessel disease. However, this is not SVT. Shocked x 2 without effect.
Beware a negative Bedside ultrasound. Young people can suffer acute coronary occlusion, whether by typical atherosclerotic plaque rupture, or by coronary anomalies, coronary aneurysms, dissections, spasm, etc. My Comment by K EN G RAUER, MD ( 1/9 /2023 ): = “ Treat the patient — Not the age of the patient”.
I suspect pulmonary edema, but we are not given information on presence of B-lines on bedside ultrasound, or CXR findings. Case Continued The patient was discharged from the hospital with a plan for a scheduled coronaryangiogram to assess the coronary arteries and the possibility of aortic valve replacement.
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