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tim.hodson Tue, 10/01/2024 - 10:50 PHOTO CAPTION: The Elucid PlaqueIQ user interface is a fully interactive visualization of the patient’s coronary anatomy, showing specific plaque type and amount across various views to inform physician assessment of risk and patient-specific treatment pathway.
Coronary Artery Disease (CAD) CAD, which involves the narrowing or blockage of coronary arteries due to plaque buildup, can reduce blood flow to the heart. This may result in ischemia (lack of oxygen to the heart muscle), causing parts of the heart to weaken and enlarge.
The fact that R waves 2 through 6 are junctional does make ischemia more difficult to interpret -- but not impossible. Back to the assessment of ischemia: Returning to the ECG, the leads that catch my eye first are -- I, II, V4, V5, V6. Ischemia can be disguised by a wide escape rhythm, which decreases the sensitivity of ECG.
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. A emergent cardiology consult can be helpful for equivocal cases.
For example, if a coronary artery becomes blocked due to plaque buildup (a condition known as coronary artery disease), the heart muscle may not receive enough oxygen, leading to chest pain (angina) or, in more severe cases, a heart attack. CAD is one of the leading causes of heart attacks.
Session 510) To Treat or Not to Treat Anatomy and Ischemia? (Session 508) Battle of the Imagers - Jeopardy Edition! Session 509) Who Wants to Be a Millionaire in Eradicating Vascular Medicine Disparities?
Only after her troponin peaked at 500,000 ng/L did she get her angiogram, which showed a 100% left main occlusion due to ruptured plaque. Young people can suffer acute coronary occlusion, whether by typical atherosclerotic plaque rupture, or by coronary anomalies, coronary aneurysms, dissections, spasm, etc. Diagnostic of Massive OMI.
That said there were no clinical symptoms or ECG findings suggestive of ongoing ischemia. There were no plaques or stenoses. 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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