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BackgroundAbdominal aortic aneurysm (AAA) is a localized bulge of the abdominal aorta, which mainly manifests as a pulsatile mass in the abdomen. Once an abdominal aortic aneurysm ruptures, the patient's life is seriously endangered. Surgery is the preferred treatment for abdominal aortic aneurysm.
Old ‘NSTEMI’ A history of coronary artery disease and a stent to the same territory further increases pre-test likelihood of acute coronary occlusion, including in-stent thrombosis. The patient had a history of ‘NSTEMI’ a decade prior, with an RCA stent. Does this change your interpretation?
Although diagnostic of MI, it is highly suspicious for " Old inferior MI with persistent ST Elevation" or "inferior aneurysm morphology" because of the well-formed Q-waves and the flat T-waves. To repeat: in contrast, anterior aneurysm is much more easily distinguished from acute MI due to the QS-waves.
Persistent ST elevation 3 days after a nearly transmural MI portends possible LV aneurysm. It is very unlikely to be LV aneurysm morphology when the ST elevation is so high and the T-Wave inversion is so deep. An open 90% LAD was stented. This 42 yo diabetic male presented with cough and foot pain. The LAD has reperfused early.
The patient is female in her 80s with a medical hx of previous MI with PCI and stent placement. These are all findings that can be expected with left ventricular aneurysm. Many advances in treatment have occurred in the 28 years since this article was published. The last echocardiography 12 months ago showed HFmrEF.
It was stented. == MY Comment by K EN G RAUER, MD ( 9/27/2019 ): == As suggested by the title of this Blog post — confirmation of the diagnosis in this case was made not by ECG — but instead by chest aorta CT ! Once dissecting aneurysm was ruled out by chest aorta CT — the possibility of acute ischemic heart disease becomes paramount.
Compare to the anatomy after stenting: The lower of the 2 now easily seen branches is the circumflex, now with excellent flow. Post-myocardial infarction (MI) ventricular septal defects are frequently seen in mid-anteroseptal and apical septal segments, whereas apex and the basal inferior segment are prone to aneurysm formation.
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