Remove AFIB Remove Plaque Remove Stenosis
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90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab?

Dr. Smith's ECG Blog

History sounds concerning for ACS (could be critical stenosis, triple vessel), but differential also includes dissection, GI bleed, etc. With the history of Afib, CTA abdomen was ordered to r/o mesenteric ischemia vs ischemic colitis vs small bowel obstruction. 2 cases of Aortic Stenosis: Diffuse Subendocardial Ischemia on the ECG.

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Noisy, low amplitude ECG in a patient with chest pain

Dr. Smith's ECG Blog

In addition, the top left blue arrow indicates a section in the LAD with a severe stenosis, likely the culprit for the prior L A D occlusion which has since recanalized. As an aside, the LCx OMI is a type 2 event, since it is due to supply-demand mismatch from thrombus, and not due to atherosclerotic plaque rupture or erosion).

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Best of cardiology in 2024 : Check it out and find the winner.

Dr. S. Venkatesan MD

Top 10 Clinical Trials Preventive PCI on Stenosis With Functionally Insignificant Vulnerable Plaque PREVENT (ACC.24) Top 10 Clinical Trials Preventive PCI on Stenosis With Functionally Insignificant Vulnerable Plaque PREVENT (ACC.24) 24) Microaxial Flow Pump in Infarct-Related Cardiogenic Shock DanGer Shock (ACC.24)