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Some patients have baseline RBBB with LAFB, but in patients with likely ACS, these are associated with severe infarction with cardiacarrest, cardiogenicshock or impending shock. Suffice it to say that, "The heart does whatever it will do when a patient is about to arrest".
The patient in today’s case presented in cardiogenicshock from proximal LAD occlusion, in conjunction with a subtotally stenosed LMCA. Distinction of PMVT vs VFib is an academic one in this case ). LAD — 100% proximal occlusion; with 70-89% mid-vessel narrowing. RCA — 100% proximal occlussion.
Admissions to CICUs with the highest tertile of CCRx utilization had a greater burden of comorbidities, had more diagnoses of ST–elevation myocardial infarction, cardiacarrest, or cardiogenicshock, and had higher Sequential Organ Failure Assessment scores. in low, intermediate, and high CCRx tertiles, respectively.
This pattern is essentially always accompanied by cardiogenicshock and high rates of VT/VF arrest, etc. The patient arrived to the ED in cardiogenicshock but awake. Plus recommendations from a 5-member panel on cardiacarrest. This one of the highest risk OMI patterns possible to see on an ECG.
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