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Cardiacarrest was called and advanced life support was undertaken for this patient. The patient was given chest compressions while waiting for the cardiacarrest team to arrive. Most such rhythms in the setting of ischemia are VF and will not convert without defibrillation. Calcium level was normal.
ST depression is common BOTH after resuscitation from cardiacarrest and during atrial fib with RVR. Again, it is common to have an ECG that shows apparent subendocardial ischemia after resuscitation from cardiacarrest, after defibrillation, and after cardioversion. The patient was cardioverted. This was done.
Although one may have all kinds of ischemic findings as a result of cardiacarrest (rather than cause of cardiacarrest), this degree of ST elevation and HATW is all but diagnostic of acute proximal LAD occlusion. This rules out subendocardial ischemia and is diagnostic of posterior OMI. V4-5 continue to show STD.
A 60-something woman presented after a witnessed cardiacarrest. This is commonly found after epinephrine for cardiacarrest, but could have been pre-existing and a possible contributing factor to cardiacarrest. Final Diagnosis: CardiacArrest due to Torsades from long QT of unknown etiology.
When I was shown this ECG, I said it looks like such widespread ischemia that is might be a left main occlusion, or LM ischemia plus circumflex occlusion (high lateral and posterior OMI). Suffice it to say that, "The heart does whatever it will do when a patient is about to arrest". There is STE in aVR.
There is no definite evidence of acute ischemia. (ie, Distinction of PMVT vs VFib is an academic one in this case ). Simply stated — t he patient was having recurrent PMVT without Q Tc prolongation, and without evidence of ongoing transmural ischemia. ( Some residual ischemia in the infarct border might still be present.
The ECG is diagnostic of LAD occlusion (or even left main occlusion possibly), with the classic pattern of RBBB and LAFB with huge concordant STE in V1-V2, I, and aVL, with reciprocal depression in most other leads (and/or a component of subendocardial ischemia pattern). Plus recommendations from a 5-member panel on cardiacarrest.
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