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Case Report: Extended cardiopulmonary resuscitation in sudden cardiac arrest after acute myocardial infarction

Frontiers in Cardiovascular Medicine

Out-of-hospital cardiac arrest (OHCA) mostly occurs in crowded public places outside hospitals, such as public sports facilities, airports, railway stations, subway stations, and shopping malls. ECMO support therapy for patients with cardiac arrest can be considered when economic conditions permit.

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Middle Aged Woman with Asystolic Cardiac Arrest, Resuscitated: Cath Lab?

Dr. Smith's ECG Blog

She went for a head CT and had a severe subarachnoid hemorrhage (SAH) due to ruptured aneurysm. What is the utility of a head CT in cardiac arrest? We found intracranial hemorrhage in 2% of non-traumatic cardiac arrest patients, and in 4 others the presence of cerebral edema changed management. Kurkciyan et al.

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Abstract 022: Acute Kidney Injury in Subarachnoid Hemorrhage: Exploring its Clinical Significance and Prognostic Implications

Stroke: Vascular and Interventional Neurology

IntroductionSubarachnoid Hemorrhage (SAH) resulting from the spontaneous rupture of an aneurysm is a rare and highly debilitating condition. Despite its severity, patients with aneurysmal SAH remain understudied, particularly concerning the evaluation of the incidence and consequences of subsequent acute kidney injury (AKI).

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See what happens when hyperacute T-waves are missed

Dr. Smith's ECG Blog

Here are his repeat ECGs after intervention: This shows new Q-waves in V4-V6, with persistent STE and positive T-waves in the anterolateral leads which matches left ventricular aneurysm morphology. These findings are consistent with full thickness infarction. Similar findings.

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1 hour of CPR, then ECMO circulation, then successful defibrillation.

Dr. Smith's ECG Blog

I suspect this is Type 2 MI due to prolonged severe hypotension from cardiac arrest. The patient's heart had significant recovery: Echo : Estimated LVEF 32%, apical wall motion abnormality with diastolic distortion (LV aneurysm), suggestive of old MI. A followup ECG was recorded 2 days later: No definite evidence of infarction.

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PseudoSTEMI and True ST elevation in Right Bundle Branch Block (RBBB). Don't miss case 4 at the bottom.

Dr. Smith's ECG Blog

An elderly patient with a ruptured abdominal aortic aneurysm: Formal ECG Interpretation (final read in the chart!) : "Inferior ST elevation, lead III, with reciprocal ST depression in aVL." Here are three more dramatic cases that illustrate RBBB + LAFB Case 1 of cardiac arrest with unrecognized STEMI, died. What do you think?

STEMI 40
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Two patients with chest pain and RBBB: do either have occlusion MI?

Dr. Smith's ECG Blog

There was 100% proximal LAD occlusion with TIMI 0 flow, and cardiac arrest in the cath lab. Peak troponin was a massive 500,000 ng/L, echo showed EF reduced to 20%, and follow up ECG showed LV aneurysm morphology with anterior Q wave and persisting ST elevation.