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This is where coronary circulation comes into play. Coronary circulation refers to the movement of blood through the network of coronary arteries and veins that supply the heart muscle (myocardium) itself. Step-by-Step Breakdown of Coronary Circulation 1.
Circulation: Cardiovascular Quality and Outcomes, Ahead of Print. Coronary anatomy and SYNTAX(Synergy between percutaneous coronary intervention with Taxus and cardiac surgery) scores were measured using coronary computed tomography angiography.
This may result in ischemia (lack of oxygen to the heart muscle), causing parts of the heart to weaken and enlarge. Regular physical activity can strengthen the heart and improve circulation. Cardiomyopathy Cardiomyopathy is a condition that affects the heart muscle, causing it to become enlarged, thick, or rigid.
This qualifies as " dynamic " ST-T wave change — and in a patient with new chest pain, this is indication for prompt cath to define the anatomy and ensure reperfusion. ECG Blog #184 — illustrates the "magical" mirror-image opposite relationship with acute ischemia between lead III and lead aVL ( featured in Audio Pearl #2 in this blog post ).
For coronary anatomy, see here: [link] This is the post intervention ECG: All ST Elevation is gone (more proof that it was all a result of ischemia) Formal Echo: Normal estimated left ventricular ejection fraction - 55%. More likely, these T waves probably reflect ischemia of uncertain age. It was stented.
Ischemic ST-Segment Depression Maximal in V1-V4 (Versus V5-V6) of Any Amplitude Is Specific for Occlusion Myocardial Infarction (Versus Nonocclusive Ischemia). 90% stenosis of the proximal ramus intermedius, pre procedure TIMI II flow The ramus intermedius is a normal variant on coronary anatomy that arises between the LAD and LCX.
Compare to the anatomy after stenting: The lower of the 2 now easily seen branches is the circumflex, now with excellent flow. Ischemic ST-Segment Depression Maximal in V1-V4 (Versus V5-V6) of Any Amplitude Is Specific for Occlusion Myocardial Infarction (Versus Nonocclusive Ischemia). Circulation 2002; 105(4): 539-42.
We know, stress tests can give false positive results suggesting ischemia in at least 20% of patients for various reasons. We are obsessed with anatomy. Our flawed intellect keeps asking this question: How can I trust physiology (Flow) without documenting a good anatomy? In fact, truth is the other way around.
That said there were no clinical symptoms or ECG findings suggestive of ongoing ischemia. CT angiogram showing a "hypoplastic" RCA and dominant LCx ( with distinction between what is a "smaller" RCA in a left-dominant circulation vs an RCA with a lumen that is "too small" sometimes being difficult ). Cardiac MRI completely normal.
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