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The best course is to wait until the anatomy is defined by angio, then if proceeding to PCI, add Cangrelor (an IV P2Y12 inhibitor) I sent the ECG and clinical information of a 90-year old with chest pain to Dr. McLaren. His response: “subendocardial ischemia. See this case: what do you think the echocardiogram shows in this case?
Compare to the anatomy after stenting: The lower of the 2 now easily seen branches is the circumflex, now with excellent flow. Next day echocardiogram showed inferolateral hypokinesia with an EF of %45-50. This is seen just millimeters beyond the tip of the catheter. The patient recovered well. His peak troponin was over 5000 ng/L.
This may result in ischemia (lack of oxygen to the heart muscle), causing parts of the heart to weaken and enlarge. Echocardiogram An echocardiogram uses sound waves to produce a detailed image of the heart, allowing doctors to see the size of the heart chambers and how well the heart is pumping blood.
We know, stress tests can give false positive results suggesting ischemia in at least 20% of patients for various reasons. The shrewd cardiologist did a bicycle ergometry and simultaneous echocardiogram without any drugs or injections. We are obsessed with anatomy. A good epicardial anatomy rarely guarantee good physiology. (It
That said there were no clinical symptoms or ECG findings suggestive of ongoing ischemia. It is reasonable to perform an echocardiogram to evaluate LV function. You have given IV MgSO4 a fast acting -blocker and IV amiodarone bolus and infusion. The possibility of an ischemic cause of the ventricular arrhythmia has to be considered!
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