Remove ACE Inhibitor Remove Cardiomyopathy Remove Thrombosis
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Abstract 4142012: Ectasias of Multiple Coronary Arteries and a Coronary Cameral Fistula Between Right Coronary Artery and Coronary Sinus

Circulation

Cardiac MRI did not show significant ischemic findings.The patient received medical therapy consisting of antiplatelet agents, high dose statin, beta blocker and ACE inhibitor, as well as diuretics. Notably, the LAD had multiple aneurysmal segments and areas of eccentric stenosis upto 90%.Multislice

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What does the angiogram show? The Echo? The CT coronary angiogram? How do you explain this?

Dr. Smith's ECG Blog

Angiogram No obstructive epicardial coronary artery disease Cannot exclude non-ACS causes of troponin elevation including coronary vasospasm, stress cardiomyopathy, microvascular disease, etc. We know that most type 1 acute MI due to plaque rupture and thrombosis occurs in lesions that are less than 50% (see Libby reference).

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Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

Dr. Smith's ECG Blog

by making it clear to everyone that this is NOT an EKG that one sees with takotsubo cardiomyopathy. Hospital Course The patient was taken emergently to the cath lab which did not reveal any significant coronary artery disease, but she was noted to have reduced EF consistent with Takotsubo cardiomyopathy.

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